Credentialing Manager at Los Angeles Center for Ear, Nose, Throat and Allergy

Los Angeles, California, United States -

Full Time

Start Date

Immediate

Expiry Date

29 Dec, 25

Salary

0.0

Posted On

30 Sep, 25

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Credentialing Management, Compliance, Provider Database Management, Documentation, Insurance Contracting, Staff Training, Problem Resolution, Collaboration, Healthcare Regulations, Organizational Skills, Communication Skills, Microsoft Office Suite, Credentialing Software, Attention to Detail, Problem-Solving Skills, Confidentiality, Professionalism

Industry

Medical Practices

Description

Description Job Summary: The Credentialing Manager will oversee and manage the credentialing and re-credentialing processes for all physicians, healthcare providers, and allied health professionals at the Los Angeles Center for Ear, Nose, Throat, and Allergy (LACENTA). The role will ensure compliance with federal, state, and regulatory requirements while maintaining high standards for quality and efficiency. The Credentialing Manager will be a key part of the operations team and collaborate closely with clinical staff, administrative departments, and regulatory bodies to facilitate the smooth onboarding of healthcare providers. Requirements Job Duties and Responsibilities: Credentialing Process Management Oversee and coordinate the credentialing and re-credentialing process for all physicians and healthcare professionals, ensuring timely submissions to health insurance companies, hospital privileges, and regulatory agencies. Compliance Ensure all credentialing practices comply with relevant federal, state, and insurance regulations (e.g., CMS, NCQA, JCAHO, etc.). Monitor changes in regulations and apply them to the credentialing processes as needed. Provider Database Management Maintain and manage an up-to-date provider database, ensuring accurate records of licensure, certifications, malpractice insurance, and education. Regularly audit files to confirm adherence to accreditation standards. Documentation and Reporting Prepare and submit credentialing packets to insurance companies and other relevant parties. Maintain accurate and complete records of credentialing files for all providers. Insurance Contracting Act as a liaison between the organization and insurance payers to ensure all credentialing information is up-to-date and providers are appropriately listed in insurance networks. Assist in managing the enrollment of new providers with health insurance plans. Staff Training and Development Provide ongoing training for administrative and clinical staff on credentialing processes, documentation, and compliance requirements. Problem Resolution Act as the primary point of contact for providers and insurance companies with questions regarding credentialing status. Troubleshoot and resolve issues in a timely manner. Collaboration Work closely with HR, legal, and clinical departments to ensure that all providers meet the necessary standards and are in good standing for employment. Assist with onboarding new hires, ensuring all credentialing paperwork is complete before provider start dates. Qualifications and Experience: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are reflective of the knowledge, skill, and/or ability required. Education Bachelor’s degree in healthcare administration, business, or a related field (or equivalent work experience). Experience Minimum of 2 years of credentialing experience in a healthcare environment, with a strong background in managing physician credentialing, preferably in a multi-specialty setting. Certifications Certification in healthcare credentialing (e.g., CPCS or CPMSM) preferred. Knowledge and Skills ? In-depth knowledge of healthcare regulations, including CMS, HIPAA, and insurance credentialing requirements. ? Strong organizational and communication skills. ? Proficiency in Microsoft Office Suite (Word, Excel, Outlook). ? Experience with credentialing software (e.g., Echo, Verity, etc.) is preferred. ? Strong attention to detail and ability to manage multiple tasks with competing deadlines. Personal Attributes ? Self-motivated, proactive, and able to work independently. ? Strong problem-solving skills and a team-oriented attitude. ? High level of confidentiality and professionalism. Physical Demands: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Individual will be required to: ? Sit for long periods at a time. ? Use hands and fingers in repetitive motions, daily. ? Ability to lift, push, pull up to 20 lbs. periodically. ? Travel to clinic locations or sites as needed. ? Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Responsibilities

The Credentialing Manager will oversee and manage the credentialing and re-credentialing processes for all healthcare providers at LACENTA, ensuring compliance with regulations and maintaining high standards. This role involves collaboration with clinical staff and administrative departments to facilitate the onboarding of healthcare providers.