Credentialing Supervisor

Partnership HealthPlan of California•Fairfield, CA

50d

About The Position

Supervise the day-to-day operations of Partnership HealthPlan of California’s (Partnership) credentialing functions. Provide leadership, support, training, and direction to the Provider Relations Credentialing Specialist staff. Ensure the highest level of accuracy and timeliness of credentialing functions, including delegation oversight. Train and monitor staff in the delivery of excellent customer service.

Requirements

Bachelor’s degree in Healthcare, Business, or related field; and minimum three (3) years of experience in healthcare, credentialing, or provider relations; or equivalent combination of education and experience.
Knowledge of medical providers and credentialing requirements.
Working knowledge of NCQA credentialing standards, credentialing practices, Medi-Cal managed care and business software applications.
Ability to implement Medi-Cal policies and procedures.
Valid California driver’s license and proof of current automobile insurance compliant with Partnership policy are required to operate a vehicle and travel for company business.
Excellent oral and written communication skills.
Excellent organization skills with the ability to prioritize assignments, maintain accurate records, and meet deadlines.
Ability to use good judgment in making decisions within scope of authority and handle sensitive issues with tact and diplomacy.

Nice To Haves

Previous supervisory experience a plus.

Responsibilities

Supervise the daily functions of the PR Credentialing staff processing credentailing and re-credentialing applications for medical providers and organizations according to National Committee for Quality Assurance (NCQA) standards.
Provide leadership, direction, training, and support to staff.
Monitor staff productivity, accuracy, and service delivery using performance standards.
Provide monthly performance feedback to staff.
Evaluate needs and conduct or arrange staff trainings.
Monitor inventory control reports weekly and adjust staff priorities based on inventory.
Produce bi-weekly inventory and aging reports.
Support staff development by identifying applicable training opportunities and training staff on new and challenging duties.
Conduct annual performance evaluations.
Monitor ACD phone usage and issue daily/weekly reports.
Interview and participate in selection of PR staff that will directly report to Supervisor.
Responsible for cross training; ensuring at least two staff can perform each function.
Participate in Partnership audits, internal and external. Prepare documentation and participate in special projects and assignments.
Ensure timelines and due dates are met.
Attend Partnership Credentialing Committee. Oversee the quality of materials presented at Credentialing meetings, ensuring agendas, supporting documents, and minutes are prepared timely and accurately.
Responsible for credentialing delegation oversight. Ensure that delegated entities submit required documents on schedule and follow-up as required.
Oversee timely audits of delegated credentialing activities.
Ensure Credentialing policies are updated and in compliance with DHCS and NCQA requirements.
Ensure desktop procedures are up-to-date.
Promote a positive attitude, team work, and fun in the workplace.