Credentialing Supervisor

HealthPartners•Bloomington, MN

13d

About The Position

HealthPartners is hiring a Credentialing Supervisor. The Credentialing Supervisor is responsible to implement, coordinate and evaluate all aspects of credentialing activities within the HealthPartners Credentialing Services Bureau, and support the management of credentialing, re-credentialing and privileging activities. To ensure compliance with applicable regulatory laws, rules, regulations, NCQA and Joint Commission accreditation standards and other internal or external customer requirements regarding the CSB aspects of credentialing and privileging. ACCOUNTABILITIES : Knowledgeable of regulatory, accreditation and other external customer requirements regarding credentialing including, but not limited to NCQA, JC, and CMS. Responsible to assist the Director and Manager to ensure credentialing processes are in compliance with NCQA, JC, MN Department of Health and CMS. Responsible for the supervision, recruitment, orientation, training, development, and day-to-day management of assigned staff. Assists the CSB Quality Assurance Coordinators (QAs) in reviewing and auditing of all completed practitioner files ensuring that all necessary elements are present and correct in the file according to corporate, accreditation, regulatory and department standards. Determines if all file and data criteria is met. Records on tracking mechanisms. Works collaboratively with QAs to ensure the highest standards of quality and accuracy of the credentialing process. Assists the QAs in reviews and audits of data entry of practitioner data in the credentialing database and records results on tracking reports to ensure accuracy, completeness and adherence to established quality standards. Reviews records and identifies barriers that encumber desired credentialing results. Develops and implements plans to remove the barriers to achieve highest level of performance. Provides mentoring to CSB staff in performing departmental tasks and plans the appropriate course of action for situations not covered by policies and procedures under the direction of the Director. Assists in day-to-day mentoring and coaching. Supports the credentialing process which may include tracking, reporting and creating of new procedures and/or policy creation. Participates in activities to develop and improve materials, policies, and procedures to support day-to-day operations. Participates in activities that support development of database program to assist in the credentialing process. Collects and reports data necessary to monitor the CSB credentialing activities. Acts as resource for Cactus database issues or questions. Works closely with Manager and Director to develop and deliver scheduled in-services and training documentation. Conducts audits and works with Credentialing Manager and Director on a variety of credentialing issues to facilitate quality assurance efforts Leads improvement processes by identifying trends, recurring issues and communication problems. Suggests new processes and/or change to existing process and/or policy and procedure. Develops and maintains department training and reference materials. Serves as a resource to staff for credentialing related questions. Provides day to day operational support, direction and leadership to assigned staff, including problem solving. Provides administrative leadership to the CSB staff in the Manager or Director’s absence. This includes providing direction, making appropriate judgment decisions, assuring that there is appropriate staffing in the CSB, coordinating and facilitating staff meetings, etc. Remains current with credentialing requirement mandated by external review agencies (e.g., NCQA, JC, and/or state and federal regulations). Works with Manager and Director to modify processes to ensure compliance with such requirements. Performs other projects and/or duties as assigned by Manager or Director.

Requirements

Bachelor’s Degree and two years managed care or health care setting credentialing experience, or high school diploma/GED and five years managed care or health care setting credentialing experience
Knowledge of and experience dealing with implementing NCQA or JC credentialing standards
Minimum of one-year leadership experience
Analytical skills required to analyze and interpret data into meaningful reports
Ability to work with multiple departments and organizations to deliver results
Strong communication skills, verbal and written

Responsibilities

Implement, coordinate and evaluate all aspects of credentialing activities
Support the management of credentialing, re-credentialing and privileging activities
Ensure compliance with applicable regulatory laws, rules, regulations, NCQA and Joint Commission accreditation standards
Assist the Director and Manager to ensure credentialing processes are in compliance with NCQA, JC, MN Department of Health and CMS
Supervise, recruit, orient, train, develop, and manage assigned staff
Assist in reviewing and auditing practitioner files
Ensure all necessary elements are present and correct in the file
Record on tracking mechanisms
Work collaboratively with QAs to ensure the highest standards of quality and accuracy
Assist in reviews and audits of data entry of practitioner data
Review records and identify barriers that encumber desired credentialing results
Develop and implement plans to remove barriers
Provide mentoring to CSB staff
Support the credentialing process which may include tracking, reporting and creating of new procedures and/or policy creation
Participate in activities to develop and improve materials, policies, and procedures
Participate in activities that support development of database program
Collect and report data necessary to monitor credentialing activities
Act as resource for Cactus database issues or questions
Work closely with Manager and Director to develop and deliver scheduled in-services and training documentation
Conduct audits and work with Credentialing Manager and Director on a variety of credentialing issues
Lead improvement processes by identifying trends, recurring issues and communication problems
Suggest new processes and/or change to existing process and/or policy and procedure
Develop and maintain department training and reference materials
Serve as a resource to staff for credentialing related questions
Provide day to day operational support, direction and leadership to assigned staff, including problem solving
Provide administrative leadership to the CSB staff in the Manager or Director’s absence
Remain current with credentialing requirement mandated by external review agencies
Work with Manager and Director to modify processes to ensure compliance with such requirements
Perform other projects and/or duties as assigned by Manager or Director