Credentialing Supervisor

Position Summary

The Credentialing Supervisor is responsible for provider credentialing, re-credentialing and delegated credentialing; ongoing maintenance of provider credentials and process; and productivity supervision of credentialing specialists.

Responsibilities

• Reports to Credentialing Manager.
• Oversees the credentialing and re-credentialing activities of all employed and/or contracted practitioners and health delivery organizations.
• Serves as the key point of contact regarding credentialing and re-credentialing issues.
• Serves as the credentialing project lead for new IPA clients.
• Develops and maintains standard operating procedures for the credentialing department.
• Prepares and maintains various reports of credentialing/re-credentialing activities.
• Supervises staff, including but not limited to the following responsibilities: trains employees, provides ongoing coaching, mentoring, and development of employees.
• Plans, schedules and directs the work of employees.
• Evaluates employees' performance and productivity.
• Reviews applications, applies policy, performs primary source verification, and processes files.
• Maintains, cross checks and updates credentialing database.
• Reviews monthly regulatory and disciplinary action reports issued by state licensure bodies, federal agents and the Office of Inspector General Medicaid and Medicare sanctions and identifies providers that appear in the databases and invokes the appropriate process, as defined in policy and procedure.
• Performs delegation audits.
• Reviews credentialing/re-credentialing files for completion and accuracy prior to submitting for approval.
• Attends and provides support for Committee meetings.
• Monitors productivity.
• Trains and educates team on new and revised policies and procedures.
• Performs regular quality checks on work/data produced by team members.
• Performs other duties as required and/or assigned.
• Performs the duties of a credentialing specialist as required or assigned.

Education & Experience Requirements

• Minimum 5 years healthcare experience in managed care credentialing.
• 1 year supervisory experience.
• Ability to manage people.
• Knowledge of NCQA, CMS and DHHS credentialing/re-credentialing standards.
• Demonstrates technical and operational knowledge and expertise.
• Cultivates positive professional and interpersonal relationships with health plans, providers and IPA.
• Excellent verbal and written communication skills.
• Ability to multi-task and prioritize workload, manage multiple priorities and pay meticulous attention to detail.

Benefits

• Full employer-paid HMO and the option for a flexible PPO plan.
• Discounted vision and dental premiums.
• FSAs to manage healthcare and dependent care costs, plus a 401(k).
• Generous PTO, 40 hours of sick pay, and 13 paid holidays.
• Tuition reimbursement.
• Paid company outings and lunches.