Job Description

The Credentialing Operations Manager will have experience in managing a provider credentialing operation, including employee production and metrics, or similar health care provider component, ensuring NCQA compliance.

Responsibilities:

. Manages the central provider credentialing functions, including managing employee production and metrics.
. Maintains regular cooperation and compliance with all regulatory, accrediting, and membership-based organizations and makes recommendations for operational changes to improve all functions for credentialing activities.
. Oversees credentialing processes in relation to physicians, medical assistants, and various other healthcare professionals; ensure that all personnel and services adhere to facility and staff policies, department guidelines, regulations, and government laws.
. Manages the scheduling and performance of staff to ensure compliance with contract requirements and maintains NCQA compliance.
. Manages processes by which provider credentialing is handled and ensures that questions and concerns are handled accurately, consistently and on a timely basis.
. Manages the development and maintenance of all training materials and arrangements for all trainings, and outreach/materials development staff.
. Ensures that all regular and ad hoc reports are submitted accurately and on time.

 

Essential Duties and Responsibilities:
- Ensure project compliance with all operational requirements of the contract as well as corporate policies.
- Manage Customer Service and Outreach Programs.
- Manage direct reports and the cost- effective operation of all project tasks.
- Supervise subcontractors that provide services to program.
- Oversee audits of operations.
- Produce monthly Service Level Agreement (SLA) report for client, as well as ad hoc reporting.
- Collaborate with other Managers to ensure effective coordination of activities.
- Develop and implement operational policies and procedures in collaboration with other key stakeholders.
- Establish and maintain effective relationships with clients and other external entities.
- Oversee the development and implementation of innovative methodologies to improve service levels and overall operation efficiency.
- Supervise the project’s quality assurance and training programs as well as corrective actions to ensure compliance.
- Monitor performance against key indicators established internally or by the clients.
- Generate solutions to issues or complex problems.
- Develop performance goals and objectives for staff, and monitor achievement of those goals.
- Perform other duties as may be assigned.

Minimum Requirements:
- Bachelor degree or equivalent combination of education, technical training or work experience considered in lieu of degree. 
- Minimum 3 years of management experience, 5 years of related experience.
- Able to manage large-scale operations, including single or multiple sites.
- Proven ability with operational analyses, processes and performance indicators.
- Capable of performing comfortably in a fast- paced, deadline-oriented work environment.
- Strong client management skills.
- Able to successfully execute many complex tasks simultaneously.
- Excellent organization, written and verbal communication skills.
- Capable of working as a team member as well as independently.

MAXIMUS Introduction
Since 1975, Maximus has operated under its founding mission of Helping Government Serve the People, enabling citizens around the globe to successfully engage with their governments at all levels and across a variety of health and human services programs. Maximus delivers innovative business process management and technology solutions that contribute to improved outcomes for citizens and higher levels of productivity, accuracy, accountability and efficiency of government-sponsored programs. With more than 30,000 employees worldwide, Maximus is a proud partner to government agencies in the United States, Australia, Canada, Saudi Arabia, Singapore and the United Kingdom. For more information, visit https://www.maximus.com.
 
EEO Statement: Active military service members, their spouses, and veteran candidates often embody the core competencies Maximus deems essential, and bring a resiliency and dependability that greatly enhances our workforce. We recognize your unique skills and experiences, and want to provide you with a career path that allows you to continue making a difference for our country. We’re proud of our connections to organizations dedicated to serving veterans and their families. If you are transitioning from military to civilian life, have prior service, are a retired veteran or a member of the National Guard or Reserves, or a spouse of an active military service member, we have challenging and rewarding career opportunities available for you. A committed and diverse workforce is our most important resource. Maximus is an Affirmative Action/Equal Opportunity Employer. Maximus provides equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status or disabled status.