Manager ,Professional Service Operations

Northside Hospital is award-winning, state-of-the-art, and continually growing. Constantly expanding the quality and reach of our care to our patients and communities creates even more opportunity for the best healthcare professionals in Atlanta and beyond. Discover all the possibilities of a career at Northside today.

Direct and execute the strategy to establish a seamless credentialing and provider enrollment processes. Manages the managed care operational infrastructure for the professional services business line. Manages team that is responsible for plan enrollment, contract compliance, and provider education. Facilitates and maintains relationships with multiple billing agents and credentialing operations. Serves as department representative for physician practices and provides negotiation and payor relationship support related to professional services.

REQUIRED:
1. Bachelors Degree

2. Strong understanding of researching and evaluating billing and claim processing errors

3. Strong understanding of evaluating physician reimbursement proposals

4. Strong understanding of professional credentialing and recredentialing requirements.

5. Strong understanding of Current Procedural Terminology

6. 5 years of Managed Care experience

7. Strong analytical skills

8. Excellent organizational skills

9. Excellent communication skills

10. Strong working knowledge of computer spreadsheet programs

PREFERRED:
1. MBA or MHA

2. Management experience

3. Strong understanding of delegated credentialing arrangements.

4. Strong understanding of Government credentialing requirements.