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Credentialing Manager 

Category Administrative  

The Credentialing Manager role works with internal and external stakeholders to assure that all clinician credentialing requirements are up to date and changes are processed accurately and in a timely manner. In addition to managing a complex and multi-system dataset, the Credentialing Specialist also fulfills a critical customer service role internally and externally in processing and submitting appropriate credentialing applications and updates to payers.

Essential Job Functions:

  • Leads all credentialing related activities for agency and assures all processes and procedures are followed.
  • Develop and implement policies and procedures for credentialing processes to assure compliance with all contractual, accreditation delegation and regulatory requirements.
  • Position may supervise credentialing staff.
  • Responsible for overall agency credentialing functions.
  • Process all facets of credentialing for agency and for agency staff, within the Medicaid and commercial insurer arena (initial credentialing, re-credentialing, staff verification, licensure updates, CAQH, NPI, NCTRACKS, etc.).
  • Communication/Coordination with program staff to ensure credentialing activities are completed in a timely and professional manner; this includes training and technical assistance to staff on credentialing timelines and activities as well as communication on status of credentialing for staff throughout the process.
  • Provides internal training and technical assistance on credentialing, state and payer database management (new applications, change applications and re- verification, e.g.).
  • Logs and tracks all credentialing activities on behalf of program staff and clinical staff.
  • Maintains current information on site identifiers and program credentials;
  • Updates state (NC Tracks; CAQH, NPPES; Alpha CMS and Provider Direct, e.g.) and internal systems to reflect changes.
  • Serves on behalf of Office Administrator for agency for state database (NC Tracks) system for Medicaid and NC Health Choice billing.
  • Maintains close working relationship with credentialing staff among payer sources.
  • Provides support to programs to initiate credentialing and re-credentialing processes.
  • Responds to internal and external requests for site and site identifier information.
Position Requirements

Minimum Qualifications:

  • Associates Degree from USDOE or CHEA accredited institution or accredited High School Diploma with 3 year’s work experience in behavioral healthcare credentialing.
  • Certification as a Certified Professional Medical Services Management (CPMSM) preferred.
  • 3-5 years’ experience working with Medicaid, Medicare, Private Insurance and Managed Care Organization (MCO) IPRS Billing or;
  • 3 years’ experience as an Office Administrator for NC Tracks or equivalent, or;
  • 3 years’ experience working in Alpha CMS and/or Provider Direct.
  • 3 years supervisory or management experience.
  • Ability to effectively communicate, both verbally and written.
  • Self-starter with a positive, outgoing personality and attitude.
  • Strong knowledge of Microsoft Office Word, Excel, and Outlook.
  • Excellent organizational skills and attention to detail.
  • Ability to multi-task and work well under pressure.
  • Ability and desire to be a team player.
  • Ability to work independently.
  • Must possess a state-appropriate, unrestricted driver’s license and personal vehicle insurance.
Full-Time/Part-Time Full-Time  
Shift -not applicable-  
Position Credentialing Manager  
Division Administration  
Exempt/Non-Exempt Exempt  
Location Administration Raleigh  
About the Organization Easterseals UCP has been part of the fabric of North Carolina and Virginia for 75 years. We started in counties all over NC and VA filling gaps and addressing the needs of children and adults with disabilities. Our legacy organizations Easterseals NC, United Cerebral Palsy NC, and Easterseals Virginia joined forces as Easterseals UCP to intentionally work side-by-side with more than 20,000 individuals and their families, providing the broad network of services and support they need to achieve better days. Today we are affiliated with both Easterseals, Inc. and United Cerebral Palsy Inc.

Our mission is to create opportunities, promote individual choice, and change the lives of children and adults with disabilities by maximizing their individual potential to live, learn, work and play in their communities.
EOE Statement We are an equal employment opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status or any other characteristic protected by law.  
SuperVFlg None Specified 

HoursPerWk None Specified 

This position is currently accepting applications.

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