Credentialing Manager (management Analyst Ii)

Fairfax, Virginia
$60,276.11 - $100,461.09 Annually
Apr 30, 2022
May 28, 2022
Full Time
Job Announcement

Works as part of the Business Operations team. Works closely with multiple CSB business operations - human resources, IT, legal, and clinical programs and sites. Ensures compliance with both facility and individual credentialing and re-credentialing duties, regulatory applications for new services, and revalidation of payor applications. Manages taxonomies and NPIs, and manages changes in the electronic health record (EHR). Develops audit tools, completes targeted audits, gives quarterly reports, completes trainings with staff in all divisions, makes recommendations for changes in business practices and processes, as well as monitors and supports programs around corrective action plans and audits.

  • Serves as the point person for all credentialing and re-credentialing activities associated with both facility and individuals for Medicare, Medicaid, 3rd Party Payers, Managed Care Organizations (MCO's), and any health plans according to their specification.
  • Manages correspondences and portals with the Centers for Medicare & Medicaid Services (CMS), State Medicaid, MCOs, third party payers, including updates, applications, and re-validation paperwork.
  • Stays current with credentialing standards for both Behavioral Health and Developmental Disabilities provider staff for all Federal, State and local regulatory agencies
  • Audits EHR and provider databases for compliance with current licenses and certifications.
Functional areas: Practice and provider management, insurance credentialing/enrollment, or medical/insurance provider relations (Note: provider relations support, develops and maintains service relationships with physicians, insurance companies, providers and administrators.)

Illustrative Duties

(The illustrative duties listed in this specification are representative of the class but are not an all-inclusive list. A complete list of position duties and unique physical requirements can be found in the position description.)
  • Performs a wide-range of professional work in multiple administration functions within an organizational unit including analysis and project management;
  • May supervise administrative and paraprofessional staff;
  • Performs a variety of technical and professional work related to monitoring and reporting on departmental business processes, activities, and outcomes;
  • Plans, develops, and implements comprehensive communication and education plans on programs and services for both county agencies and community organizations;
  • Assists with developing and conducting special studies and research initiatives, by designing survey instruments, gathering data and information from department staff, developing data analysis tools, conducting statistical analyses, initiating literature reviews, etc.;
  • Conducts analysis and reporting of quantitative and qualitative data in order to track and monitor various business process indicators;
  • Serves as the point-person and liaison within the department and with central county
  • departments regarding a designated program and functional areas of responsibility;
  • Prepares reports and presentations of analysis and findings.

Required Knowledge Skills and Abilities

(The knowledge, skills and abilities listed in this specification are representative of the class but are not an all-inclusive list.)
  • Knowledge of the mission, goals and objectives of the organizational unit, program or activities to which incumbent is assigned;
  • Knowledge of the principles, practices, and techniques relating to various functional areas of business operation (e.g., personnel, budgeting and financial management, contract administration and management);
  • Knowledge of the principles, practices and techniques governing management, organization, operations and programmatic services;
  • Ability to identify and describe a range of possible solutions for solving business problems;
  • Ability to apply research methods to design studies and assessments, and statistical analysis techniques to identify patterns and trends in data;
  • Ability to use word processing and presentation software to prepare documents, and to use spreadsheet and statistical analysis software packages to store, manipulate, analyze and present data;
  • Ability to train, lead, and/or supervise paraprofessional staff.

Employment Standards

Any combination of education, experience, and training equivalent to the following:
(Click on the aforementioned link to learn how Fairfax County interprets equivalencies for "Any combination, experience, and training equivalent to")
Graduation from an accredited four-year college or university with a bachelor's degree in the field related to the assigned functional area; plus two years of professional work experience within the functional area.

Valid driver's license.

The appointee to this position will be required to complete a criminal background check, a Child Protective Services Registry check, driving record check, and a sanction screening to the satisfaction of the employer. A TB screening upon hire.

All newly hired employees are required to be fully vaccinated against COVID-19 (two weeks after the last required dose) as a condition of employment or obtain approval of a medical or religious exemption prior to their start date. Proof of an exemption or vaccination status will be required during the pre-employment onboarding process. New employees who obtain an exemption from the vaccine mandate for medical or sincerely held religious beliefs may be subject to a weekly testing requirement. Vaccinated employees and employees with a medical or religious exemption will complete the attestation online on their first day of employment or shortly thereafter.

  • Four (4) or more years of experience in practice management.
  • Three (3) or more years of experience in the medical services profession.
  • Three (3) or more years of experience working with Managed Care Organizations.
  • CPCS Certified or Eligible for the CPCS Certification (Certified Provider Credentialing Specialist).
Ability to travel throughout the county for CSB meetings. Ability to stand, sit, and walk as needed to perform core job functions. Must be able to lift up to 25 pounds All duties performed with or without reasonable accommodations.

Panel interview and may include a practical exercise.

Fairfax County Government prohibits discrimination on the basis of race, color, religion, national origin, sex, pregnancy, childbirth or related medical conditions, age, marital status, disability, sexual orientation, gender identity, genetics, political affiliation, or military status in the recruitment, selection, and hiring of its workforce.

Reasonable accommodations are available to persons with disabilities during application and/or interview processes per the Americans with Disabilities Act. Contact 703-324-4900 for assistance. TTY 703-222-7314. EEO/AA/TTY.

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