Remote Manager of Credentialing

Crossroads Treatment Centers is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees.

Crossroads is a leading addiction treatment provider of outpatient medication-assisted treatment (MAT). We treat patients with opioid use disorder (OUD) using medications such as methadone and suboxone/ buprenorphine. We pride ourselves in supporting our patients' medical and personal recoveries from substance use disorder. Starting our fight against the opioid addiction crisis in 2005, Crossroads has remained physician led and patient focused as we've grown to 100+ clinics across nine states. As an equal opportunity employer, we celebrate diversity and are committed to an inclusive environment for all employees and patients.

Day in the Life

40% Credentialing and Privileging

Ensure credentialing processes are in compliance with professional standards, bylaws, state and federal regulatory requirements with such organizations such as the National Committee for Quality Assurance (NCQA), Centers for Medicare and Medicaid (CMS), Utilization Review Accreditation Commission (URAC).Develops credentialing and privileging policies and procedures. Reviews policies to assure incorporation of regulatory changes; and recommends changes, revisions and enhancements as needed in accordance with best practices.Oversees and supports the day-to-day operations of Credential/Privileging processes.Facilitates the implementation of credentialing committee recommendations and follow-through.Oversees and maintains credentialing database; generates reports and prepares audits as requested.Function as primary contact for all internal and external inquiries regarding Credentialing and Privileging, and potential and/or existing practitioners regarding credentialing.Act as a liaison between department and clinical areasIdentifies opportunities to improve processes and systems.20% Strategic Planning

Advises organization leadership on changing regulatory requirements and implications for our business model.Reviews and responsible for providing oversight and management of department budgeting and forecasting, goals, and initiatives.Provides feedback regarding provider licensing, privileging, and regulatory planning for all new sites and acquisitions.20% Department Management

Provides day-to-day supervision of staff with ongoing feedback and evaluation of work performed, including hiring, terminations, annual performance reviews and staffing needs.Acts as a role model and serve as a leader and resource for staff.Provides training of new employees and cross-training to provide coverage when staff is absent, or workload demandsServes as facilitator and essential link between health plans to ensure patient access and claim(s) reimbursementOversees for the submission of provider information to health plans for inclusion in health plan networks.Oversees the notification to health plans of provider terminations and reassignment of membership when applicable.Oversee the notification to health plans of provider information/demographical updates and changes as well as practitioner panel changes.Responsible for monthly, quarterly, and semi-annual reporting of credentialing activities to health plans.Education and Licensure Requirements

Bachelor's degree in business or related field, or equivalent experience.Minimum of three to five years of supervisory experience.Minimum of five years in a Credentialing/Medical Staff environment.Excellent working knowledge of PECOS, CAQH and NPI Data BasePosition Benefits

Medical, Dental, and Vision InsurancePTOVariety of 401K options including a match program with no vesture periodAnnual Continuing Education Allowance (in related field)Life InsuranceShort/Long Term DisabilityPaid maternity/paternity leaveMental Health DayCalm subscription for all employees