Manager of Credentialing in Etters at Rite Aid

Date Posted: 1/6/2020

Job Snapshot

Job Description

Job Description



SUMMARY

Responsible for all aspects of the credentialing, recredentialing, and privileging processes for all medical providers who provide patient care.  This will ensure that the company minimizes any risk of not being paid for medical services. Frequent independent judgments are essential. The incumbent is also required to perform all tasks in observance of Rite Aid’s brand and strategy and adhere to our core values and service attributes.

ESSENTIAL DUTIES AND RESPONSIBILITIES

The associate is responsible for the functions below, in addition to other duties as assigned:

  •  Compiles and maintains current and accurate data for all providers
  •  Completes provider credentialing and recredentialing applications; monitors applications and follow-up as needed. Familiar with NCQA standards
  •  Maintains copies of current state licenses, necessary certificates, malpractice coverage and any other required credentialing documents for all providers
  •  Prepares and leads the Credentialing Committee
  •  Maintains knowledge of current health plan and agency requirements for credentialing providers
  •  Tracks license and certification expirations for all providers to ensure timely renewals
  •  Ensures practice addresses are current with health plans, agencies, and other entities
  •  Processes applications for appointment and reappointment of privileges to RediClinic
  •  Tracks license and professional liability expirations for appointed RediClinic providers
  •  Maintains appointment files and information in credentialing database
  • Prepares and submits paperwork required for managed care provider enrollment and updates EMR accordingly


Supervisory Responsibilities

This position directly supervises This position directly supervises  and carries out supervisory responsibilities in accordance with Rite Aid policies and applicable laws. Responsibilities include interviewing, hiring, training, directing, rewarding, and disciplining associates; appraising associate performance; and resolving complaints., Specialists/ Coordinators, and carries out supervisory responsibilities in accordance with Rite Aid policies and applicable laws. Responsibilities include interviewing, hiring, training, directing, rewarding, and disciplining associates; appraising associate performance; and resolving complaints

 


Experience / Requirements

  • Relevant credentialing experience required. required
  • Or equivalent combination of education and experience 


Education

  • Bachelor’s Degree in Arts/Sciences (BA/BS)  required