Supervisor, Credentialing Quality

CVS Health•Work At Home-Texas, TX

3d•$43,888 - $85,068

About The Position

The Credentialing Quality Supervisor oversees the day-to-day activities of the Senior Credentialing Specialists who are responsible for auditing the quality and accuracy of all applications reviewed by our credentialing team. You will play a critical role in maintaining our high standards by ensuring error-free processing and compliance. The Supervisor will maintain strong cross-departmental relationships with Credentialing Operations, Recruiting, and Compliance. This role will report to our Operations Manager. Diversity and Inclusion are core values at Signify Health and fostering a workplace culture reflective of that is critical to our continued success as an organization.

Requirements

2 to 5 years leadership experience
3 to 5 years of successful work experience, preferably in a credentialing/auditing role
2 to 3 years’ experience stakeholder management. Demonstrates active listening skills and strong interpersonal skills, with the ability to build rapport and productive relationships with internal and external stakeholders
Must be familiar with NCQA accreditation standards.
3 to 5 years of experience using reporting tools including Excel and Power BI
Intermediate proficiency in G-Suite (Docs, Sheets, Slides, etc.).
Uncompromising attention to detail and accuracy, with an analytical mindset for spotting errors.
Strict adherence to HIPAA regulations regarding Protected Health Information (PHI).

Nice To Haves

Previous experience in credentialing quality assurance, auditing, or as a Senior Credentialing Specialist, with a deep understanding of NCQA credentialing standards.
Proven experience leading a team, with a focus on fostering a collaborative and productive work environment preferred.
The ability to work overtime as needed to meet audit deadlines.

Responsibilities

Manage the daily workflow of the Senior Audit Specialists to ensure timely and accurate completion of quality reviews for all credentialing and re-credentialing applications.
Responsible for pulling and analyzing regular reports to monitor team performance and operational metrics. Utilize specific internal systems to extract data, identify trends, and provide actionable insights to leadership.
Oversee the audit process to ensure provider files strictly adhere to Federal, State, NCQA, and client policy requirements associated with delegated credentialing.
Provide guidance, coaching, and regular performance feedback to the senior audit team to align with individual, department, and company goals.
Train new Senior Specialists on the credentialing audit process, quality standards, error-reporting procedures, and NCQA guidelines. Meets with Ops Mgr regularly to provide updates, reporting and feedback.
Analyze audit data to identify error trends, processing bottlenecks, and training opportunities for the broader credentialing team to improve overall quality.
Serve as the final reviewer for complex credentialing audits, discrepancies, or appeals regarding additional verifications (such as State Board Licenses and Department of Defense requests).
Lead and assist with special projects to support quality operations and operational needs as directed by management.