Credentialing Operations Lead

Advanced Medical Management, Inc.; Long Beach (CA); On-site; USD 95,000 - 115,000; Full time

Benefits offered by this job

Health coverage

Vision & dental benefits

401(k) and FSAs

Paid holidays

Job summary

Advanced Medical Management, Inc. is seeking a Credentialing Supervisor responsible for provider credentialing, re-credentialing and delegated credentialing; ongoing maintenance of provider credentials and process; and productivity supervision of credentialing specialists.

The role oversees credentialing activities for all employed and/or contracted practitioners, serves as the key contact for credentialing issues, and leads projects for new IPA clients while developing SOPs and reports.

Qualifications

• Minimum 5 years healthcare experience in managed care credentialing.
• 1 year supervisory experience.
• Knowledge of NCQA, CMS and DHHS credentialing/re-credentialing standards.
• Ability to train and develop staff; manage performance.

Responsibilities

• Oversees credentialing and re-credentialing activities for employed and contracted practitioners.
• Serves as primary contact for credentialing issues.
• Acts as project lead for new IPA clients.
• Develops and maintains standard operating procedures for the credentialing department.
• Prepares and maintains reports of credentialing activities.
• Trains and coaches team; directs workload and evaluates performance.
• Reviews applications, performs primary source verification, and processes files.
• Maintains credentialing database and ensures data accuracy.
• Reviews regulatory reports and flags providers in sanctions databases.
• Attends and supports Committee meetings.
• Performs quality checks on team data and other duties as assigned.

Skills

People management

Verbal & written communication

Multi-tasking & prioritization

Interpersonal relationships

Job description

Advanced Medical Management, Inc. is seeking a Credentialing Supervisor responsible for provider credentialing, re-credentialing and delegated credentialing; ongoing maintenance of provider credentials and process; and productivity supervision of credentialing specialists.

The role oversees credentialing activities for all employed and/or contracted practitioners, serves as the key contact for credentialing issues, and leads projects for new IPA clients while developing SOPs and reports.