Manager Provider Support Services

Provider Support Services Manager

At OrthoCarolina, our team is our greatest asset and the foundation of our success. We are a diverse group of individuals, accountable to each other to uphold the standards of excellence and promote an environment of teamwork throughout the organization. OrthoCarolina has 43 unique care locations with over 1300 professionals who share a common goal to make lives better. Our employees are eligible for a full spectrum of benefits including paid company holidays, wellness programs, and tuition reimbursement.

OrthoCarolina is seeking a qualified professional to join our team as a Provider Support Services Manager.

The Provider Support Services Manager leads a team of dedicated individuals to ensure all applications for initial credentialing, recredentialing, hospital and ASC privileging for practitioners, (physicians, physician assistants, nurse practitioners, organization, clinics, DME, etc.) for appropriate hospitals, managed care organizations and malpractice insurance coverage are completed and processed in a timely manner. Maintains licensure (including medical license, DEA and privilege license) for physicians, physician assistants and clinics. Maintains current documentation on medical providers for hospitals and participating managed care organizations.

Essential Functions :

• Manages the applications process for initial credentialing and re-credentialing for hospitals, managed care organizations in a truthful, complete and timely manner. Processes applications and secures malpractice insurance coverage for physicians and physician assistants and nurse practitioners.
• Manages and coordinates the prioritization of the credentialing process for current and new providers, hospital appointments / reappointments, privileges, licenses, DEA's, Medicare enrollments, facility enrollments, continuing medical education and NC medical licenses.
• Manages the high level of communication required with managed care representatives to resolve practitioner participation issues.
• Coordinates credentialing / re-credentialing process by maintaining communication and assistance with other OrthoCarolina employees, hospital medical staff departments, representatives from managed care organizations and malpractice underwriter by gathering appropriate credentialing and re-credentialing information such as signatures and documents.
• Maintains current credentialing files of medical practitioners to include state licensure, DEA, certificate of insurance, board certification and CMEs.
• Renews state license and DEA for physicians, fellows, physician assistants, and nurse practitioners. Maintains tracking renewal dates.
• Assists new physicians and physician assistants / nurse practitioners in scheduling hospital orientations and interviews necessary to obtain hospital privileges.
• Responsible for written notification to hospitals, managed care organizations and malpractice carrier of all practitioners, clinic and organization changes / terminations.
• Develops and documents the credentialing and re-credentialing process for hospital privileges and managed care participation for physicians, fellows, physician assistants, nurse practitioners, organization, clinics, DME, etc.
• Responsible for the oversight of the Provider Support Coordinator team as well as quarterly check-ins and annual evaluation.

Qualifications :