Supervisor, Managed Care

NAVISTA

3d•$80,900 - $133,980•Hybrid

About The Position

Practice Operations Management oversees the business and administrative operations of a medical practice. Managed Care oversees the interactions that take place between payer and provider(s) to ensure optimal reimbursement including managed care contracting, enrollment, credentialing, and any other activity as it relates to payer interaction. The position is responsible for managing the credentialing/enrollment team and ensuring an active status with all contracted payors for all groups and providers. The position is also responsible for ensuring licensure is updated and active for all groups, providers, and facilities.

Requirements

At least five (5) years of experience of credentialing experience in a managed care or provider setting, including experience using a credentialing database preferred
Demonstrated personnel leadership (remote and onsite), provider enrollment technical expertise, effective and professional communication, disciplined execution of strategic initiatives, and relationship management preferred
Specific knowledge of the payer environment and payer issues, particularly billing and collections.
Strong knowledge of the rules/regulations of Medicare/Medicaid and other government payors, as well as commercial insurers and specialty contracts to ensure accurate and timely billing and payment of claims.
Ability to work a flexible schedule (including overtime, and weekends), as necessary.
Excellent customer service and communication skills.
Ability to work independently and as part of a team.
Working experience with Excel spreadsheets and Microsoft Word documents.

Responsibilities

Supervises day-to-day credentialing/enrollment operations, including assigning and balancing workloads across the team, reviewing work output for accuracy and completeness, and providing timely feedback and coaching to team members.
Responsible for identifying performance gaps and escalating unresolved issues to manager.
Responsible for documenting and tracking all credentialing, re-credentialing, provider enrollment, and hospital privileging activities within the credentialing software environment.
Assists new providers with obtaining required clinical licenses and coordinates the full cycle onboarding and enrollment into Medicaid, Medicare, and the commercial insurance plans.
Develops, documents, and maintains standard operating procedures (SOPs) for all credentialing and enrollment workflows, including provider onboarding.
Ensures SOPs are current, accessible to team members, and updated when processes or platforms change.
Conducts periodic reviews of existing procedures and recommends improvements to manager.
Conducts regular quality audits of team members' credentialing and enrollment work, documenting findings, and implementing corrective actions.
Maintains audit cadence and reports results to manager.
Plans and delivers training for new and existing team members on credentialing/enrollment workflows, platform functionality, payer requirements, and departmental SOPs.
Coordinate with platform subject matter resources for system-specific training content.
Maintains training documentation and tracks completion.
Serves as the first point of escalation for credentialing and enrollment issues that cannot be resolved at the coordinator level.
Triages, tracks, and resolves or escalates issues to manager within documented timeframes.
Maintain and monitor all licenses and certifications in the database to ensure compliance.