Be An Important Part of The Alliance’s Mission!
The Alliance moves health care forward by controlling costs, improving quality, and engaging individuals in their health. As a not-for-profit, employer-owned cooperative, we exist to help our members manage their health care dollars while positively impacting their employees’ health.
This newly created role will have oversight of the provider credentialing program at The Alliance to ensure compliance with established corporate, state, and national standards and in accordance with National Committee for Quality Assurance (NCQA) guidance. The Credentialing Manager leads the relationships and contracting with credentialing vendors. Additionally, this role advises The Alliance Leadership Team of recommended enhancements to credentialing the provider network to minimize the organizations risk.
Provider Credentialing Program Oversight: Manages existing relationships with vendors to fulfill credentialing needs. Ensures that the Provider Credentialing Program meets NCQA guidance and modifies processes to ensure compliance. Works to ensure vendor partner relationships remain positive and progressive, including but not limited to billing accuracy, regular communication, and determining future opportunities. Responsible for developing and maintaining policies regarding provider enrollment/registration. May lead and assist the organization toward NCQA accreditation.
- Processes and Reporting: Will recommend and help lead staff efforts toward implementation of process and system enhancements to improve efficiency of credentialing processes and perform provider reporting to ensure programs are being executed efficiently.
- Credentialing Committee: Will recommend action The Alliance should take based on information from vendor Credentialing Committees. May recommend and lead efforts for The Alliance to establish its own Credentialing Committee.
- Delegated Credentialing Agreement Management: Responsible for executing and maintaining delegation of credentialing agreement with network providers. Will recommend a process toward maintenance of delegation agreements that coincides with NCQA guidance.
- Strategic Initiatives: Will keep abreast of industry initiatives including NCQA progress, provider enrollment, and credentialing modifications and continually recommend initiatives that advance The Alliance toward goals and objectives that further the mission of patient safety.
- Coordination with Provider Operations Staff: Responsible for working collaboratively with Provider Operations staff in efforts toward carrying out credentialing data management and the Provider Credentialing Program. Will train Provider Operations staff regarding credentialing processes and assist them in responding to provider inquiries regarding credentialing.
- Project Management: Responsible for successful coordination and management of projects related to provider credentialing and provider enrollment initiatives.
In addition to excellent credentialing, communication, and relationship building skills, the ideal candidate will have a bachelor’s degree in health care, business, or related field (or equivalent experience), have certification as either NAMSS and/or CPCS, and a minimum of five years’ experience in credentialing in healthcare insurance.
We offer flexible scheduling, including working 4 ½ days/week during the summer. Additionally, post-training, this position can mostly work remote – if desired – but you may be required to attend in-person meetings with teammates or other key stakeholders a few times per month.
As a not-for-profit cooperative, The Alliance is employer-owned and remains a trusted, objective partner for employers and their brokers who seek improved access to high-quality healthcare.
We’re Madison-based, but we work with 300+ employers across the Midwest and contract with over 34,000 doctors and other health care providers in the region. Our goal is to help employers better manage their healthcare costs while remaining transparent and emphasizing value – creating healthier, more engaged workforces.
The Alliance is celebrating over 30 years as a mission-driven and member-focused collective with experienced leadership and strong organizational departments backed by top talent. By joining The Alliance, you’ll become part of a passionate, collaborative, and supportive organization: one that fosters meaningful connections and relationships with high levels of employee engagement and satisfaction.
Our health plan is self-funded, which means we share the same interests and use the same tools that we offer our clients. We lead by example because when we take care of our employees, they take care of our clients (and their employees.)
We set our employees up for success, encouraging not only their professional advancement but also their personal growth. We offer a competitive compensation and benefits package, including health, dental, vision, and life insurances, a generous Staff Incentive Bonus program, 401(k), and annual Continuing Education and Wellness benefits.
To learn more about The Alliance click here.
The Alliance is unable to provide sponsorship for a H1-B work visa at this time.
Equal Opportunity Employer.