Job Summary:
Baylor Genetics (BG) is expanding its market access capabilities. BG has extensive experience in the hospital setting and is expanding its business to the outpatient setting. BG seeks coverage and reimbursement for genetic testing with commercial health plans to serve patients with answers that matter. To that end, we are hiring a senior manager to ensure Baylor Genetics has full provider enrollment and appropriate credentials with Medicare, Medicaid, Tricare, and Commercial payers to ensure effective contracting and billing operations.
The Senior Manager of Credentialing is responsible for managing a team that will deliver accurate and timely credentialing and recredentialing activities for all payers within the Baylor Genetics network. This position ensures strict adherence to organizational credentialing policies and procedures, as well as compliance with the credentialing requirements set forth by our health plan partners and relevant regulatory and accrediting agencies.
Education and Experience:
- Minimum of 7 years of experience within Market Access and Credentialing Services
- Associate degree in health services or a similarly related field with 2+ years of managerial experience in credentialing services
- In lieu of degree, 9 years of healthcare staff experience with at least 2 years of managerial experience in credentialing services.
- Preferred bachelor’s degree with experience of 7 years
- Certified Provider Credentialing Specialist (CPCS) preferred
- Diagnostic Laboratory experience preferred
- Experience managing or leading training teams is preferred.
Key Responsibilities:
- Ensure compliance with payer contract credentialing requirements
- Collaborate closely with Legal, Finance, Laboratory, Regulatory Affairs, and Revenue Cycle Management teams to acquire requisite information and deliver appropriately completed documents to payer organizations.
- Provide innovative, organized and effective solutions for credentialing processes and day to day business operations.
- Verify that all prospective applications and addendums are complete, signed, and dated.
- Perform primary source verification on each application criteria.
- Assure that all credentialing files are processed according to Baylor Genetics’ Credentialing Policy and Procedures.
- This position ensures that credentialing practices are also consistent with industry practice standards.
- Independently manage and review credentialing requests, audits conducted on behalf of BG, and monitors audits and reviews conducted by regulatory agencies of BG testing, such as Medicare reviews.
- Gather and review all appropriate contractual, internal policy and/or regulatory documentation pertinent to the assigned audit/monitoring process.
- Develop and implement policies and procedures to guide all credentialing activities
- Provide analytics and data driven insights to assist in the development of recommendations for process improvement within our credentialing and provider data
- As part of portal access administration, provide Revenue Cycle Management staff members with user-access to the portals, so that they can perform their normal duties such as eligibility, claims, etc.
- As part of portal access administration, provide any reporting that is needed by Revenue Cycle Management regarding the payer portals.
- Update the provider profile when any company changes happen that impact the billing system, such as new bank account information, or if the billing vendor is changed.
- Manage credentialing team to meet and exceed service requirements and functional objectives
- Monitor team production on a daily, weekly, and monthly basis and actively address individual production concerns and barriers to meeting metrics
- Prepare and deliver performance appraisals, working through all issues and managing performance in a way that provides the highest level of productivity and quality across the team
- Direct and mentor staff in a constructive and positive manner to foster employee relationships and development
- Serve as the lead on all credentialing-related matters, including annual audits and payer requests
Skills and Competencies:
- Knowledge of the payer payment system in the U.S.
- Ability to manage projects and work cross-functionally with Market Access and other team members (e.g., Sales, Legal, Laboratory)
- Effective written/oral communication and presentation skills
- In-depth knowledge of best practices, credentialing and reappointment requirements, Provider Bylaws/Rules and Regulations, and accrediting/regulatory requirements.
- Proven experience in creating and maintaining technical documentation such as job aids, manuals, and standard operating procedures.
- Proven ability to work cross-functionally with other departments, especially in a client-facing capacity, is a plus.
- Strong knowledge of applicable software programs and personal computer skills
- Ability to read and comprehend instructions, short correspondence, memos, and write correspondence.
- Ability to effectively present information in one-on-one and small group situations for credentialing purposes
- Ability to apply common sense understanding to carry out instructions furnished in written, oral, diagram form.
- Ability to problem solve in a variety of situations within the organization to carry out credentialing functions
- Ability to effectively motivate and manage staff of individual contributors to meet departmental and corporate objectives.
Physical Demands and Work Environment:
- Frequently required to sit, talk, and hear.
- Regular use of computer, keyboard, and standard office equipment.
- May be required to manage priorities in a fast-paced, deadline-driven environment.
EEO Statement:
Baylor Miraca Genetics, LLC is proud to be an equal opportunity employer committed to fostering a diverse and inclusive workplace. We welcome applicants of all backgrounds and do not discriminate based on race, color, religion, sex, national origin, age, disability, veteran status, sexual orientation, gender identity, or any other protected status under applicable laws.
