Credentialing Team Lead

HealthDrive is seeking an organized full-time Credentialing Team Lead to join our team. This position will be responsible for ensuring all provider types are appropriately credentialed and re-credentialed in a timely manner with Medicare, Medicaid, and other third-party payers, by both the internal Credentialing Coordinators as well as the company’s external third-party credentialing vendor. Additionally, this position will work on project work in Regulatory Affairs with some minor administrative duties.

We are conveniently located off Route 9 in Framingham, MA, close to routes 90 and 495 in a spacious modern office with a workout center available right in the building!

What's in it for you: PPO Medical, Dental, and Vision Insurance, 401(k) + Company match, Paid Time Off, hybrid schedule opportunity, monthly meal program, Verizon Wireless, Dell, and other employee discounts, profit sharing, and employee referral bonuses.

HealthDrive delivers on-site dentistry, optometry, podiatry, audiology, behavioral health, and primary care services to residents in long-term care, skilled nursing, and assisted living facilities. Each specialty offered by HealthDrive is one that directly impacts the quality of daily life for the deserving residents we serve. HealthDrive connects patients in need of vital healthcare to doctors committed to dignity and excellence.

HealthDrive is a place where everyone can grow and training is provided. Join our diverse team today!

• Maintains high-quality, up-to-date, and accurate credentialing processes for all provider types.
• Monitors collection of information and documents received ensuring all items required for credentialing are received during the onboarding process.
• Advises Supervisor of any questionable information received, and any issues identified during the processes.
• Monitors the insurance payer requests in the internal Credentialing application as well as in the company’s third-party credentialing vendor’s portal.
• Works with and assists company’s third-party credentialing vendor and internal Credentialing Coordinators for accurate and timely completion of payer applications, collection of provider signatures, and tracking of payer credentialing until approvals are received.
• Holds company’s third-party credentialing vendor to contracted SLAs.
• Reviews provider expiring document reports and payer revalidation due date reports to ensure that all required documents have been renewed and payer revalidations submitted.
• Other duties and responsibilities as assigned.

Skills

• Outstanding organizational skills and attention to detail.
• Excellent judgment & prioritization skills proactively prioritize needs and effectively manages    resources.
• Must have excellent communication skills: verbal, interpersonal and written. This includes strong spelling and grammar skills and basic mathematical calculations.
• Must have strong ability to self-direct and work both independently and with a team in a high-volume, deadline-driven role.
• Prior insurance payer credentialing experience required.
• Customer orientation: establishes and maintains long-term customer relationships, building trust and respect by consistently meeting and exceeding expectations.
• Policies & procedures: articulates knowledge and understanding of organizational policies, procedures, and systems.
• PC Skills: demonstrates proficiency in Microsoft Office (Excel, Access, Word) applications and other as required.
• Ability to maintain confidentiality of privileged information gained.

Education & Qualifications

• High school diploma or equivalent required; Associate degree preferred.
• Payer credentialing experience strongly preferred.

Work Environment

Office setting. Desk/Computer/General office equipment. The noise level in this work environment is usually light to moderate.

Physical Requirements

• Ability to sit for long periods of time.
• Ability to use office equipment such as computer, phone, fax, and copier.
• Ability to lift up to 10 lbs. occasionally for duties related to office work.