Supervisor, Credentialing

Description

Supervises Credentialing staff, including manage day to day operation, interviewing, hiring, performance evaluation and training employees;

Planning projects distribution, assigning, and directing work to the credentialing team.

Develops resolution for identify issues, coaching the team to resolve the obstacles, addressing complaints and resolving escalated issues from the external departments.

Administers and oversees the practitioner and provider credentialing process for Blue Shield of California with minimal guidance from management.

Must have full knowledge of files review to meet all state and federal guidelines.

Must have full knowledge of ongoing monitor process for provider sanctions.

Must have strong timeline management and supervising the team to process initial, credentials and projects within the required timeframe.

Able to run a meeting with external departments to address special project issues and questions.

Assists Credentialing Committee Medical Director based on established guidelines and committee meeting follow-up.

Provides technical support and guidance to team members and educates team members on guidelines and procedures.

Must have communicating skills with external and internal sources to verify or clarify potentially sensitive information pertinent to the application and credentialing process with minimal guidance from manager.

Establishes follow-up procedures for periodic updates and review of current network credentialing status and provide report to the manager.

Participates in formal and informal reviews and fair hearings and takes and disseminates minutes as appropriate; and Implements credentialing process with support and guidance from manager.

Qualifications

Minimum 3 years of experience in health plan credentialing at a supervisor level.

Experience with NCQA accreditation survey process.

Proficiency in computer and software programs (e.g., Microsoft Word, Excel, Access, CAQH, CACTUS, Power Points).

Must have excellent organization, management, written, verbal communication skills.

Detail oriented.

Must be a team player with professional demeanor, possess a good work ethic, be a problem solver and take personal pride in its own work.

Physical RequirementsOffice Environment - roles involving part to full time schedule in Office Environment. Based in our physical offices and work from home office / deskwork Activity level : Sedentary, frequency most of work day.