Credentialing Supervisor

JOB OVERVIEW:

Responsible for oversight of workflow of all aspects of the credentialing, re-credentialing and privileging processes for medical providers who provide patient care at West Cancer Center. Must work to ensure credentialing is completed efficiently and effectively.  Identify potential issues and work to ensure they do not interfere with target completion of tasks. Review issues, and work proactively and independently, when possible, to solve them. Work to improve current processes and develop new ones when necessary. Works with SVMIC underwriter on obtaining malpractice insurance for physicians, allied health providers, and fellows. Credentialing Supervisor responsible to assist incoming fellows and out of state providers with obtaining appropriate state licensure.

Responsible for direct oversight of credentialing staff. Responsible for new hires, training, arranging schedules and coverage for leave and annual evaluations. Credentialing Supervisor must be able to successfully perform all the daily jobs performed by Credentialing Specialist and Credentialing Assistant.

ESSENTIAL FUNCTIONS INCLUDE BUT ARE NOT LIMITED TO:

• Oversees gathering and sustaining of an accurate practitioner record by utilizing West Cancer Center credentialing software.
• Implements policies and procedures to ensure applications are properly completed t before they sent to providers for signatures.
• Assists Credentialing team with review of completed on the websites or in the MD-Staff credentialing and re-credentialing applications.
• Assigns New Providers and follow-up tasks in MD-Staff to Credentialing Specialist as needed.
• Audits MD-Staff Software for accuracy of copies of current state licenses, DEA certificates, malpractice coverage, board certifications, and any other required credentialing documents for all providers.
• Works with SVMIC underwriter to obtain malpractice insurance for physicians, allied health providers, breast & call fellows, and group.
• Responsible for updates to management or providers when notifications received from hospitals, payers, medical boards, etc.
• Ensures credentialing team is signed up to receive all updates. Responsible to keep up with updates received from hospitals, payers, medical boards, etc.
• Makes sure Credentialing Department maintains provider credentialing files up to date by running Ad Hoc Queries in MD-Staff.
• Creates and schedules when needed MD-Staff Ad Hoc Queries when new reports are requested.
• Has great knowledge of current health plans, hospital requirements, malpractice requirements for credentialing providers. Makes sure hospital, insurance enrollment requirements and contact information is current in the MD-Staff credentialing software.
• Tracks license, DEA, Life Support, and Board Certification expirations for all providers to ensure timely renewals. Regularly communicates with state licensure boards.
• Responsible for overseen accuracy of the provider profiles in the NPPES NPI Registry, CAQH and PECOS.
• Audits hospital and health plan directories for current and accurate provider information.
• Oversees the work performance of Credentialing Department team members including outsourced staff.
• Responsible for new hires, training, arranging schedules and coverage for leave and annual evaluations.
• Writes concise, organized, grammatically correct emails, reports, letters, and memos.
• Communicates with managers and team members effectively.
• Displays leadership qualities and compliance with company policies.
• Promotes and maintains exceptional customer service.
• Maintains high levels of service and responsiveness by providing high quality work completed in an accurate, confidential, efficient, and timely manner.
• Maintains a professional approach respecting the dignity and confidentiality of patients and employees.
• Attends staff/manager meetings as scheduled.

QUALIFICATIONS:

Education:  High school diploma or equivalent required. AB/AA/BA/BS/BBA preferred, but not required.

Experience: Minimum 4-5 years of substantial credentialing experience required. Credentialing experience for a provider group preferred.

Must have excellent organization and follow-up skills; excellent verbal and written communication skills, excellent problem-solving skills, ability to organize and prioritize work assignments; ability to handle multiple priorities in a fast-paced environment; ability to analyze situations and respond in a timely manner; ability to participate in multi-functional teams; ability to oversee the work performance of others; ability to establish and maintain effective working relationships within The West Clinic; ability to establish and implement new processes; must be proficient in computer applications, including word processing, spreadsheet, and e-mail.  Additional hours may be required.

Skills:

1. Knowledge and understanding of the credentialing process.
2. Ability to organize and prioritize work and manage multiple priorities.
3. Excellent verbal and written communication skills including letters, memos and emails.
4. Excellent attention to detail.
5. Ability to research and analyze data.
6. Ability to work independently with minimal supervision.
7. Ability to establish and maintain effective working relationships with providers, management, staff, and contacts outside the organization.
8. Proficient use of Microsoft Office applications (Word, Excel, Access) and internet resources.