Category: Uncategorized

Clipped from: https://www.indeed.com/q-Medicaid-l-New-Jersey-jobs.html?vjk=fa0df92336159560&advn=940939426731412

Job Summary

The Director of Credentialing for the Medical Group possesses primary responsibility for leading and managing operational requirements of the Credentialing Department in support of the medical group as well as the health care system. The Director will effectively lead and serve as the subject matter expert on all credentialing and privilege processes for medical providers and allied health professionals ensuring consistency, accuracy and compliance with established protocols, accrediting and regulatory agencies. The Director of Credentialing coordinates and collaborates with RWJBH business leaders and colleagues on day-to-day operations as it relates to credentialing.

Essential Functions

• Develops, implements, and maintains credentialing processes and procedures to meet the needs of practices, hospitals, payers, the market, state regulations and NCQA, Medicare/Medicaid, delegated credentialing and any other credentialing parties.
  
• Ensures ongoing compliance with state regulatory, legislative, NCQA, Medicare/Medicaid, Joint Commission, payer credentialing, and accrediting body requirements or laws.
  
• Directs and coordinates all credentialing activities for department staff, related committees (Credentialing and Appeal Committees), and third party credentialing provider (symplr). Ensures consistent, accurate, and timely execution of credentialing processes and information.
  
• Represents the Credentialing Department at medical group, system, and state/regulatory meetings. Partners with business leaders as it relates to operations and credentialing initiatives.
  
• Prepares and maintains regular department reporting and credentialing database.
  
• Establishes strategic goals in alignment with corporate objectives, setting priorities and managing department performance to meet developed goals.
  
• Manages and maintains department budget.
  
• Completes managerial duties as it relates to staffing, scheduling, performance reviews, workflows, staff development and training.
  
• Other duties or special projects as assigned.
  

Job Requirements

• Bachelor’s degree required. Master s degree preferred. Appropriate experience may be substituted for education requirements.
  
• Minimum 5 years of credentialing experience to include at least 8 years management or supervisory experience in a credentialing setting required.
  
• Professional Medical Services Management Certification (CPMSM) or Professional Credentialing Specialist Certification (CPCS) preferred; or the ability to obtain certification(s) within one year of employment.
  
• Knowledge of credentialing software (symplr ) preferred.
  

Other Duties:

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.

RWJBarnabas Health is the most comprehensive health care delivery system in New Jersey, with a service area covering five million people. The system includes eleven acute care hospitals Clara Maass Medical Center in Belleville, Community Medical Center in Toms River, Jersey City Medical Center in Jersey City, Monmouth Medical Center in Long Branch, Monmouth Medical Center Southern Campus in Lakewood, Newark Beth Israel Medical Center in Newark, RWJUH- New Brunswick, RWJUH- Somerset in Somerville, RWJUH- Hamilton, RWJUH- Rahway and Saint Barnabas Medical Center in Livingston; three acute care children s hospitals and a leading pediatric rehabilitation hospital (Children s Specialized Hospital), a freestanding 100-bed behavioral health center, trauma centers, a satellite emergency department, ambulatory care centers, geriatric centers, the state s largest behavioral health network, comprehensive home care and hospice programs, fitness and wellness centers, retail pharmacy services, a medical group, multi-site imaging centers and an accountable care organization.

RWJBarnabas Health Medical Group is a multispecialty group practice comprised of highly trained and experienced world class primary and specialty care physicians. RWJBarnabas Health Medical Group physicians provide compassionate and innovative cutting-edge care for people at every stage of life at easily accessible facilities conveniently located throughout New Jersey. Backed by the vast continuum of resources of RWJBarnabas Health, the largest not-for-profit integrated health care delivery system in New Jersey and one of the largest in the nation, our dedicated physicians and expertly trained supporting staff continuously strive for clinical excellence.

We offer a great work environment, competitive rates and excellent benefits, including:

• Medical/Dental/Vision plans
  
• 401 (k)
  
• PTO
  
• Short & Long Term Disability
  
• Basic Life & Accidental Death Insurance
  
• Tuition Reimbursement
  
• Health Care/Dependent Care Flexible Spending Accounts
  

Senior Sales Executive Government Medicaid Payment Integrity Payment Accuracy

Change Healthcare is a leading healthcare technology company with a mission to inspire a better healthcare system. We deliver innovative solutions to patients, hospitals, and insurance companies to improve clinical decision making, simplify financial processes, and enable better patient experiences to improve lives and support healthier communities.

Senior Sales Executive Payment Integrity – Payment Accuracy – State Medicaid

The Solution Sales Executive (State Medicaid focus) is responsible for acting as the sales lead in closing new opportunities in the State Medicaid Agency by demonstrating the unique value proposition of CHC Payment Accuracy Solutions.

What will be my duties and responsibilities in this job? Identifying opportunities to sell CHCs Payment Accuracy solutions into net new and existing customers

• Directing and conducting sales presentations with Solution Consultants and/or Client Executives
  
• Collaborating with Account Managers and SSEs to coordinate efforts in identifying leads
  
• Maintaining thorough understanding of the State Medicaid Agency market nationally with emphasis on delivery of CHC Payment Accuracy solutions.
  
• Orchestrate and lead detailed pre-sales planning and strategy, post sales handoff to implementation and ongoing knowledge transfer to Client Executives
  
• Negotiate and close contracts and coordinate with CHC legal and product as needed.
  
• Professional and effective communication skills required including comfort with conversations that create clarity and improve collaboration at all levels within complex and diverse organizations
  
• Effective analytical, problem-solving, and decision-making skills
  
  What are the requirements needed for this position?
  
• Education/Training BA/BS, MBA preferred.
  
• Minimum of 5 -10 years Sales experience selling Payer Payment software/Payment services directly to Goverment State Medicaid Agencies and/or through Fiscal Intermediaries and/or BPO/Business Processing Outsourcing Firms.
  
• Experience developing a footprint across the U.S and upselling, nurturing business relationships, retaining and expanding our clients footprint.
  
• Demonstrated track record & proven quota performance selling to the State Medicaid market
  
• Keeping all opportunities current within Salesforce and providing updates to CHC Management
  
• Experience with Excel, CRM tools, and Net Promoter Score preferred
  
  What other skills/experience would be helpful to have?
  
• We will also consider candidates that have experience selling healthcare payer services
  
• Extensive knowledge of Payment Accuracy/Payment Integrity/Cost Containment/Fraud Waste Abuse, Special Investigation Unit/SIU solutions in the healthcare and payer marketplace
  
• Experience selling healthcare software solutions and services directly to State Medicaid Agency
  
• Proficient at executing when experiencing multiple competing priorities
  
• Strong interpersonal and communication skills
  
• The ability to build relationships across the organization, especially at the Payer C-Level and collaborate as necessary to accomplish goals
  
• Maintain State Medicaid industry, product specific knowledge and competitor differentiation
  
• Strong organizational and time management skills
  
• Successful track record of working as a part of dynamic, fast-paced and growing teams that are results oriented and collaborative.
  
• Effective analytical, problem-solving and decision-making skills.
  
  What are the working conditions and physical requirements of this job?
  
• General office demands
  
  How much should I expect to travel?
  
• Employees in roles that require travel will need to be able to qualify for a company credit card or be able to use their own personal credit card for travel expenses and submit for reimbursement.
  
• Willingness and ability to travel 70% of the time depending on COVID travel restrictions / Current State: We are visiting some clients and not travel 70%.
  
• Territory: National
  
• You can be based out of within 1 hour of major airport
  

li-remote Diversity and Inclusion:

At Change Healthcare, we include all. We celebrate diversity and inclusivity, respect each other and value our unique experiences. By being our authentic selves, we bring different perspectives into our work and relationships.Business Resource Groups (BRGs) play a central role in advancing diversity and inclusion at Change Healthcare. They deepen our understanding of different cultures, people, and experiences, and help foster an inclusive workplace. Change offers eight (8) BRGs. Learn more at Feeling Inspired? Ready to ? Apply today!

COVID Vaccination Requirements

We remain committed to doing our part to ensure the health, safety, and well-being of our team members and our communities. As such, we require all employees to disclose COVID-19 vaccination status prior to beginning employment and, when j ob-related and consistent with business necessity , we may require periodic testing for certain roles. Some roles require full COVID-19 vaccination as an essential job function. Change Healthcare adheres to COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance.

Equal Opportunity/Affirmative Action Statement

Change Healthcare is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity, genetic information, national origin, disability, or veteran status. To read more about employment discrimination protections under federal law, read EEO is the Law at and the supplemental information at

If you need a reasonable accommodation to assist with your application for employment, please contact us by sending an email to with “Applicant requesting reasonable accommodation” as the subject. Resumes or CVs submitted to this email box will not be accepted.

Click here to view our pay transparency nondiscrimination policy.

California (US) Residents: By submitting an application to Change Healthcare for consideration of any employment opportunity, you acknowledge that you have read and understood Change Healthcares Privacy Notice to California Job Applicants Regarding the Collection of Personal Information () .

Change Healthcare maintains a drug free workplace and conducts pre-employment drug-testing, where applicable, in accordance with federal, state and local laws.

Change Healthcare is an equal opportunity employer. All qualified applicant will reveive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity, genetic information, national origin, disability, or veteran status.

Clipped from: https://jobs.myarklamiss.com/jobs/senior-sales-executive-government-medicaid-payment-integrity-payment-accuracy-frankfort-kentucky/712274918-2/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic