Credentialing Supervisor

Overview:

Train and monitor staff in the delivery of excellent customer service.

Responsibilities:

• Supervise the daily functions of the PR Credentialing staff processing credentailing and re-credentialing applications for medical providers and organizations according to National Committee for Quality Assurance (NCQA) standards.
• Provide leadership, direction, training, and support to staff.
• Monitor staff productivity, accuracy, and service delivery using performance standards.
• Provide monthly performance feedback to staff.
• Evaluate needs and conduct or arrange staff trainings.
• Monitor inventory control reports weekly and adjust staff priorities based on inventory.
• Produce bi-weekly inventory and aging reports.
• Support staff development by identifying applicable training opportunities and training staff on new and challenging duties.
• Conduct annual performance evaluations.
• Monitor ACD phone usage and issue daily/weekly reports.
• Interview and participate in selection of PR staff that will directly report to Supervisor.
• Responsible for cross training; ensuring at least two staff can perform each function.
• Participate in PHC audits, internal and external. Prepare documentation and participate in special projects and assignments.
• Ensure timelines and due dates are met.
• Attend PHC Credentialing Committee. Oversee the quality of materials presented at Credentialing meetings, ensuring agendas, supporting documents, and minutes are prepared timely and accurately.
• Responsible for credentialing delegation oversight. Ensure that delegated entities submit required documents on schedule and follow-up as required.
• Oversee timely audits of delegated credentialing activities.
• Ensure Credentialing policies are updated and in compliance with DHCS and NCQA requirements.
• Ensure desktop procedures are up-to-date.
• Promote a positive attitude, team work, and fun in the workplace.

Qualifications:

Education and Experience

Bachelor’s degree in Healthcare, Business, or related field; and minimum three (3) years of experience in healthcare, credentialing, or provider relations; or equivalent combination of education and experience. Previous supervisory experience a plus. Knowledge of medical providers and credentialing requirements.

Special Skills, Licenses and Certifications

Working knowledge of NCQA credentialing standards, credentialing practices, Medi-Cal managed care and business software applications. Ability to implement Medi-Cal policies and procedures. Valid California driver’s license and proof of current automobile insurance compliant with PHC policy are required to operate a vehicle and travel for company business.

Performance Based Competencies

Excellent oral and written communication skills. Excellent organization skills with the ability to prioritize assignments, maintain accurate records, and meet deadlines. Ability to use good judgment in making decisions within scope of authority and handle sensitive issues with tact and diplomacy.

Work Environment And Physical Demands

Ability to use a computer keyboard. More than 30% of work time is spent in front of a computer monitor. When required, ability to move, carry, or lift objects of varying size, weighing up to 35 lbs.

All HealthPlan employees are expected to:

• Provide the highest possible level of service to clients;
• Promote teamwork and cooperative effort among employees;
• Maintain safe practices; and
• Abide by the HealthPlan’s policies and procedures as they may from time to time be updated.

HIRING RANGE:

$93,690.86 - $117,113.58

IMPORTANT DISCLAIMER NOTICE

The employer reserves the right to revise this job description at any time and to require employees to perform other tasks as circumstances or conditions of its business, competitive considerations, or work environment change.