Supervisor, Centralized Operations Unit

About the role

The supervisor works within a high volume, goal-driven environment (estimated target: 75 to 100 files per week across a team).

Responsibilities

• Directly supervises 3 - 6 staff members responsible for using medical staff credentialing and provider payer enrollment techniques, workflows, and best practices.
• Implements credentialing and health plan payer enrollment function processes and monitors assigned staff compliance.
• Audits files for completion, monitors results, and gains/sustains stakeholder buy-in.
• Initiates and cultivates partnerships with other members of the Centralized Processing team, department management, medical staff /hospital/health plan/payor leadership and information technology teams to ensure compliance and optimal efficiency for appropriate membership for UCSF Medical Staff, Advanced Practice Professionals and CVO contracted facilities (LPPH&C, School of Dentistry and others, as applicable).
• Responds to data integrity/system interface issues, primary source credentialing information, onboarding and revenue channel disruptions as well as performs auditing functions pursuant to facility Bylaws, Rules and Regulations; Credentialing Policy and Procedures; and other applicable accreditation/payor standards (e.g. NCQA, TJC, DHS, DMHC, CMS, delegated credentialing agreements, etc.).
• Includes responsibilities and involvement in the department’s engagement, educational, and professional development activities (i.e. Staff Engagement Committee, Education & Development Committee, Diversity, Equity, and Inclusion Committee, etc.) to achieve department and organization goals/work plans.
• Facilitates team meetings, prepares agendas and related materials for team huddles, medical staff meetings, and peer review activities.
• Maintains compliance with medical staff bylaws, provider enrollment requirements, rules, regulations, policies, and procedures.
• Interprets and develops policy and procedures, and manages training and orientations to a variety of constituents to sustain best practices.

Requirements

• Five years in a healthcare environment with emphasis in medical staff operations, academic medical centers and/or provider enrollment for third party payors and health plans.
• Three or more years working as a lead/supervisor or manager role.
• Expert knowledge of TJC, NCQA, CMS, DHS, DMHC, ACGME and other applicable accreditation/regulatory requirements.
• Demonstrated leadership skills.
• Motivates and inspires staff to improve the workflows and operations of the organization.
• Solid customer service skills.
• Demonstrated ability to effectively manage multiple priorities.
• Maintains a broad range of external regulatory best practices and accounting and administrative operations.
• Proven ability to apply knowledge to recommend improvements.
• Actively cooperates and supports the work of others.
• Effective communicator with peers, clinical staff, regulatory agencies, and multidisciplinary team members.
• Advanced critical and analytical thinking regarding complex and long-term projects.
• Ability to recognize impediments, creatively address new problems, develop alternative plans, and formulate solutions.
• Advanced organizational and project management skills, including the ability to anticipate and plan for complex situations, define objectives, and adjust plans.
• Ability to see multiple assignments through, from inception to completion on schedule.
• Ability to maintain a professional demeanor while working under pressure of constantly changing deadlines and priorities; possesses poise, diplomacy, discretion, initiative, resourcefulness, and a service orientation.
• Skills to interact with a diverse population of internal staff, physicians and administrators, external agencies, and physicians' offices.
• Demonstrated advanced computer skills using Microsoft Office Suite (Word, Excel, PowerPoint) and medical credentialing database application.
• Advanced knowledge of data analysis, research and reporting, particularly regarding licensure compliance.

Qualifications

• The ability to obtain one of the following within the first eight months of employment: Certified Provider Credentialing Specialist (CPCS), Certified Professional Medical Services Management (CPMSM), Certificated Professional in Healthcare Quality (CPHQ) or Certified Professional Coder.
• The ability to work onsite in our San Francisco office at least three days a week or more as required.