Credentialing Operations Team Lead / Supervisor

MultiPlan-posted 5 months ago

$55,000 - $70,000/Yr

Full-time • Manager

Remote • Bedford, MA

Professional, Scientific, and Technical Services

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At Claritev, we pride ourselves on being a dynamic team of innovative professionals. Our purpose is simple - we strive to bend the cost curve in healthcare for all. Our dedication to service excellence extends to all our stakeholders - internal and external - driving us to consistently exceed expectations. We are intentionally bold, we foster innovation, we nurture accountability, we champion diversity, and empower each other to illuminate our collective potential. Be part of our amazing transformational journey as we optimize the opportunity towards becoming a leading technology, data, and innovation voice in healthcare. Onward and Upward!!!

Ensure all (re)credentialing processes are in compliance with NCQA accreditation standards.
Oversee operational processes cycle in support of staff, time and quality objectives for (re)credentialing.
Manage recredentialing of non-respondent inventories.
Assure compliance of staff for all applicable policies and procedures.
Produce reporting for staff productivity auditing for data integrity.
Identify training needs for staff surrounding the credentialing and recredentialing process.
Collaborate on projects according to the needs of the department.
Select, develop, and evaluate staff to ensure the efficient operation of department.
Collaborate and communicate across disciplines and departments.
Ensure compliance with HIPAA regulations and requirements.
Responsible for routine internal monitoring and auditing of compliance risks.

Minimum Bachelor's degree, or 3 years of related operations and/or credentialing experience.
Minimum 3 years of experience in related managed healthcare environment including minimum 3 years of project management and supervisory experience.
Required licensures, professional certifications, and/or Board certifications as applicable.
Active or actively pursuing Certified Provider Credentialing Specialist (CPCS) certification.
Knowledge of accreditation standards related to NCQA, and state regulatory agencies.
Knowledge of the Company's data systems and familiarity with Imaging/Workflow Environment.
Communication (oral, written and listening), prioritization, organizational, project and process management skills.
Ability to lead, motivate and mentor individuals and teams.
Ability to negotiate and coordinate activities of individuals and groups.
Ability to effectively manage resources and workflow for multiple projects simultaneously.

Knowledge of departmental processes and its relationship with organizational objectives and outcomes.
Ability to use software, hardware and peripherals related to job responsibilities including MS Office.
Ability to manage operations in a data driven environment.
Ability to work with and understand complex data systems.
Ability to focus on results and successful achievement of business objectives.
Ability to take action independently by gathering information, identifying tasks and following through.
Ability to collaborate with others to ensure best practices are explored, implemented and shared.
Ability to develop and maintain cooperative relationships at all levels of organization.

Medical, dental and vision coverage with low deductible & copay.
Life insurance.
Short and long-term disability.
Paid Parental Leave.
401(k) + match.
Employee Stock Purchase Plan.
Generous Paid Time Off - accrued based on years of service.
10 paid company holidays.
Tuition reimbursement.
Flexible Spending Account.
Employee Assistance Program.
Sick time benefits - for eligible employees.

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