Credentialing Supervisor

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

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-DUTIES

• Reports toCredentialing 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.
• Reviews credentialing/re-credentialing files for completion and accuracy prior to submitting for approval.
• Attends and provides support for Committee meetings.
• 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 and 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.

AMM BENEFITS

When you join AMM, you’re not just getting a job—you’re getting a benefits package that puts YOU first:

• Health Coverage You Can Count On: Full employer-paid HMO and the option for a flexible PPO plan.
• Wellness Made Affordable: Discounted vision and dental premiums to help keep you healthy from head to toe.
• Smart Spending: FSAs to manage healthcare and dependent care costs, plus a 401(k) to secure your future.
• Work-Life Balance: Generous PTO, 40 hours of sick pay, and 13 paid holidays to enjoy life outside of work.
• Career Development: Tuition reimbursement to support your education and growth.
• Team Fun: Paid company outings and lunches because we work hard, but we also know how to have fun!