HSCSN Mgr Cred Prov Data Mgmt

Health Services for Children with Special Needs
Washington, DC
Category Healthcare
Job Description
The Credentialing and Provider Data Manager oversees provider credentialing, recredentialing, and provider data integrity within a health plan. The role ensures compliance with federal and state regulations and contractual obligations, and supervises the Provider Data Specialist and Credentialing Coordinators.

Requirements

  • Bachelor's Degree (Preferred)
  • 7 years Credentialing experience (Required)
  • 5 years Supervisory or management experience (Required)
  • Certified Provider Credentialing Specialist (CPCS) 1 Year (Required)
  • Excellent written and verbal communication skills
  • Strong presentation skills
  • In-depth knowledge of health plan and medical staff credentialing practices
  • Strong familiarity with accreditation standards and regulatory frameworks
  • Proven ability to improve process efficiency and implement system automation
  • Experience with credentialing software and provider data systems
  • Ability to interpret documents, licenses, certifications, and accrediation standards
  • Ability to manage multiple priorities in a fast-paced environment
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