Credentialing, Privileging & Enrollment Supervisor

WELLSPACE HEALTH • Sacramento, CA

9h • Onsite

About The Position

The Credentialing & Privileging Supervisor oversees the full lifecycle of provider credentialing, recredentialing, and privileging for all licensed, certified and other clinical staff. This role ensures compliance with California regulations, HRSA FTCA requirements, Medicare/Medicaid enrollment, payer credentialing, and NCQA/Joint Commission standards. The supervisor leads credentialing staff, manages workflows, ensures data accuracy, and collaborates with leadership, providers, and external agencies to maintain timely and compliant credentialing processes.

Requirements

• Bachelor’s degree in business or healthcare administration or related field or 5 years’ experience in hospital and/or healthcare credentialing in lieu of education
• Must have Medical Staff Services certification: Certified Professional Medical Services Management (CPMSM), Certified Provider Credentialing Specialist (CPCS) or Certified Professional Medical Services Management (CPMSM) credential from National Association Medical Staff Services (NAMSS).
• Knowledge of credentialing rules and regulations, as well as accrediting organization standards, Center for Medicare and Medicaid Services (CMS) regulations, state regulations and other regulatory agencies as they pertain to medical staff and allied health professionals
• Knowledge and experience with audits from TJC, FTCA, plans/IPA, etc.
• Minimum 1–2 years of supervisory or lead experience in credentialing
• Demonstrated ability to supervise up to 5 employees
• Experience working in Human Resources department
• Able to communicate effectively in English, both verbally and in writing
• Excellent interpersonal skills
• Knowledge of basic anatomy and physiology, medical terminology and functions of medical staff services
• Advanced computer skills in word processing, spreadsheets and databases
• Excellent organizational skills
• Must be willing to successfully complete the credentialing process.

Nice To Haves

• Fluency in additional languages preferred

Responsibilities

• Oversees the credentialing & privileging process to ensure that all individuals credentialed and/or granted clinical privileges are qualified to provide patient care, treatment and services based upon the scope of their training, licensure and experience.
• Supervises the Credentialing & Enrollment team to ensure optimum performance of the department.
• Functions as a member of Human Resources and acts as the subject matter expert for credentialing, privileging and enrollment.
• Ensures compliance with rules and regulations, allied health professional's policies, other policies and procedures and appropriate regulatory agency standards.
• Audits, supervises and evaluates processes involved in verifications for licensed and certified providers and allied health professional’s application, and evaluates processes involved in verifications for licensed and certified providers and allied health professionals’ appointments, reappointments, appointments reappointment and privilege delineation.
• Coordinates the processing of candidates’ applications that require credentialing & privileging. Assures that all applications are processed completely and in a timely manner in accordance with HR guidelines.
• Audits applications, reviews supporting documents, including all primary source verification for all credentialing and re-credentialing to ensure allied health professional files are current and policies and procedures are followed to obtain required documentation and verification.
• Coordinates activities, provides statistical information and explains procedures to facilitate the reappointment process.
• Maintains and monitors confidential information for credentialing, HR, and peer review discussions and other sensitive matters.
• Organizes and supports the Credentialing Committee.
• Responsible for assuring that the findings, conclusions and recommendations for actions to appoint or reappointment applicants and/or improve the credentialing program are reported through appropriate leadership, and that approved actions are then assigned and/or implemented in a timely manner.
• Improves professional growth, knowledge of job to maintain efficiency and effectiveness of the Credentialing department by belonging to professional organizations, attending seminars, and reading journals and publications.
• Assures the ongoing development and implementation of policies and procedures that guide and support the provision of services.
• Possesses working knowledge of state and federal law relating to due process and provisions of the Health Insurance Portability and Accountability Act (HIPAA) of 1996 and accrediting organization standards.
• Supports and maintains a culture of safety and quality.
• Other duties as assigned.

Benefits

• Successful candidate will receive regionally competitive salary, above average health benefits at reduced costs, company paid life insurance & long-term disability insurance, additional voluntary retirement plan with company match and no vesting schedule requirement.
• Paid bereavement and jury duty leave
• 11 paid holidays per year
• Paid time off
• Paid sick leave
• Flexible Spending Program
• Professional development hours offered annually

What This Job Offers

• Job Type: Full-time
• Career Level: Manager
• Number of Employees: 251-500 employees