Supervisor Credentialing

CommunityCare; Tulsa (OK); On-site; USD 85,000; Full time

Job summary

CommunityCare is seeking a Credentialing Supervisor to oversee credentialing personnel and ensure compliance with policies and procedures. The ideal candidate will have experience in managed care and be able to communicate effectively across departments. This mid-senior level role is full-time and offers competitive salary and benefits including medical and vision insurance, 401(k), and tuition assistance.

Benefits

Medical insurance

Vision insurance

401(k)

Tuition assistance

Disability insurance

Qualifications

• 3 years of experience in managed care, health insurance and/or health care setting.
• Previous credentialing experience required.
• 2 years supervision experience preferred.

Responsibilities

• Supervise credentialing personnel and maintain workflows.
• Ensure compliance with credentialing policies and procedures.
• Report on credentialing activities and oversight of processes.

Skills

Supervision

Communication

Confidentiality

Teamwork

Education

Associate’s degree in business, healthcare or related field

Certification in credentialing (CPMSM or CPCS)

Tools

Microsoft applications

Job description

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Responsible for supervising credentialing personnel and oversight of training. Supervise workflows and projects to support timely, efficient production. Responsible for ensuring credentialing policies and procedures are compliant with regulatory agencies and accreditation standards.

KEY RESPONSIBILITIES:

• Provide day-to-day supervision of personnel. Evaluate performance of direct reports and provide regular feedback individually and to the team. Identify improvement opportunities to support continuous development. Assists in the maintenance of MD Staff Software to ensure quality provider data. Responsible for updating policies and procedures with regard to all credentialing and provider data processes.
• Assists in coordinating the agenda, reporting and follow-up of activities related to the Credentials Committee. Responsible for ongoing sanctions review of all providers through internal monitoring activities. Coordinate, assist in, and follow up of the weekly audit of credentialing files.
• Responsible for supervision, including monitoring and assessing reports, to ensure providers are credentialed in accordance with state mandates, and policy and procedures. Responsible for oversight of initial processes, reappointment processes, and CAQH utilization.
• Report on credentialing activities and performance to the appropriate internal committees. Responsible for interdepartmental communication to provide and receive assistance regarding credentialing applications for both initial and reappointment applications. Responsible for processing credentialing related invoices and statement, including Credentials Committee Stipends, for appropriate approvals and submission to Accounts Payable.
• Assists in the Delegated Credentialing Oversight activities.
• Perform other duties as assigned.

QUALIFICATIONS:

• Ability to effectively supervise others, to include the ability to maintain a positive working environment, project a positive attitude, and be a self-starting individual and maintain a team player attitude.
• Ability to work within cross-functional teams and to build effective working relationships to achieve performance objectives.
• Possess strong oral and written communication skills with an ability to interpret and communicate information effectively, including with all levels of employees as well as external stakeholders.
• Ability to handle confidential information in a professional and sensitive manner.
• Basic knowledge in Microsoft applications.

EDUCATION/EXPERIENCE:

• 3 years of experience in managed care, health insurance and/or health care setting
• Previous credentialing experience
• Associate’s degree in business, healthcare or related field preferred
• 2 years supervision experience preferred
• Certification in credentialing (CPMSM or CPCS) preferred

Seniority level

• Seniority level

  Mid-Senior level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Health Care Provider, Management, and Quality Assurance

• Industries

  Insurance and Hospitals and Health Care

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Inferred from the description for this job

Medical insurance

Vision insurance

401(k)

Tuition assistance

Disability insurance

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