Gateway Learning Group, a San Francisco-based fast growing business in the education/health sector, is seeking a full-time experienced provider credentialing manager.
Lead company’s provider credentialing process, overseeing day-to-day tasks of two staff
members for credentialing and re-credentialing new and current employee providers of
ABA (Applied Behavioral Analysis) therapy to children on the Autism spectrum.
Interprets healthcare insurance company requirements and disseminates information to
all involved parties, internally and externally to assure necessary compliance,
compatibility and continuous quality improvement of credentialing processes.
Monitors company’s BCBA’s (Board Certified Behavioral Analysts) and RBT’s (Registered
Behavioral Techs) for credentialing and recredentialing compliance and submission to
various Health System entities, e.g. insurance companies, Medicare and Medi-Cal.
Ensure the accuracy and integrity of the credentialing database system and related
applications, and the seamless, timely flow of credentialing information to meet
verification and re-credentialing deadlines of Health Insurance Payers.
Interpret basic health insurance company and related contracts, ensuring compliance with
appropriate healthcare insurance company credentialing guidelines.
Conduct audits and provide solutions to reduce errors and improve processes, compiling
credentialing statistics for internal tracking and reporting.
Inform Gateway President and Revenue Cycle leadership of key issues, acts as agent in
influencing changes in Program quality and agency requirements.
Develop and implement streamlined processes that meet requirements and adhere to
Credentialing Policies and Procedures.
Creates credentialing communications to support company business objectives.
Coach, train credentialing staff, and collaborate with other department staff.
Performs miscellaneous job-related duties as assigned
Minimum 1–3 years experience in a healthcare credentialing lead or supervisory position.
Associate's degree in health care administration, public health, or related field required, OR 3 years of work experience in a directly related field required. * High School Diploma or General Education Development (GED) required.
Gateway Learning Group is a San Francisco-based, fast growing business in the education/health sector. Gateway Learning Group provides specialized instruction to children and teens with autism and other special needs in their homes, schools, and/or communities.