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Manager - Provider Credentialing Team Leader
Manager - Provider Credentialing Team Leader
JOB SUMMARY: This position is responsible for leading an operations team that is responsible for primary source verification of practitioners whom are currently contracted or wish to be contracted with the Company, researching and consulting on standard and escalated practitioner credentialing matters. Participates in and leads the work of subordinates.
JOB ROLES AND RESPONSIBILITIES:
1. Supervise the day-to-day operation of assigned functional areas including but not limited to the monitoring of individual and staff workload, operational productivity and performance, and management of procedures and workflows.
2. Manage high priority and specialized requests as appropriate.
3. Engage department staff in operations improvement initiatives with an emphasis on coaching, mentoring, and quality/productivity optimization. Ensure credentialing coordinators are informed of changes made to the credentialing process. Analyze and recommend changes to department management that will optimize the credentialing process.
4. Identify and resolve issues that impact department operations by working closely with internal and external staff to resolve issues as necessary.
5. Ensure all credentialing processes are in compliance with company policies as well as the National Committee for Quality Assurance (NCQA) standards in an effort to maintain accreditation by effectively and efficiently managing department activities.
6. Perform industry and systems research to troubleshoot and resolve credentialing issues in support of Network Development, Service Operations and other departments, as requested.
7. Serve as a subject matter expert for all credentialing activities performed within assigned area including the education and training of customers on credentialing methodologies and approaches, with an emphasis on operational efficiency and quality optimization.
8. Assist the Manager with operational tasks associated with credentialing operations associated with staff extenders.
9. Serve as a subject matter expert to the IT department relative to development and maintenance of systems and applications used by credentialing operations.
10. Participate in projects that involve the collection of credentialing applications, processing and system design and re-design related to the credentialing operations.
11. Research and resolve escalated credentialing issues (e.g. NDOPS, Push backs) as assigned by the Manager.
12. In collaboration with the management team, develop, maintain and present to management regularly (daily, weekly, monthly, quarterly, yearly) a suite of standing and ad hoc management reports which may include but are not limited to: department inventories, productivity, quality and performance relative to key performance indicators.
13. Select, develop, and evaluate staff to ensure the efficient operation of department. Train and mentor all assigned staff and manage performance activities; participate in recruitment and engagement efforts for all positions.
14. Collaborate, coordinate, and communicate across disciplines and departments.
15. Ensure compliance with HIPAA regulations and requirements.
16. Demonstrate Company s Core Competencies and values held within.
17. The position responsibilities outlined above are in no way to be construed as all encompassing. Other duties, responsibilities, and qualifications may be required and/or assigned as necessary.
The Team Lead operates under limited supervision as an integral member of the management team. The Team Lead interacts independently with all levels in order to effectively represent their functional unit and participates in/leads initiatives and projects that will contribute to furthering the organization s mission and goals. The Team Lead has regular interaction with colleagues internal and external to the department. The position will directly supervise a team of credentialing coordinators. The position will be responsible for assisting the manager with the supervision of a team of offsite staff extenders performing credentialing business processes on behalf of the Company.
JOB REQUIREMENTS (Education, Experience, and Training):
* Bachelor s degree in business or healthcare administration, or minimum HS Diploma and 3 years of experience in provider credentialing.
* Minimum 3 years of experience in provider credentialing. Experience working in initial credentialing and/or re-credentialing of practitioners, is preferred.
* Minimum 1 year experience in people coaching/mentoring role preferably as a senior staff member or team leader
* Knowledge of accreditation standards related to NCQA, URAC and state regulatory agencies
* Knowledge and experience working with complex data processes, including analysis
* Required licensures, professional certifications, and/or Board certifications as applicable
* Communication (written, verbal, listening), leadership, team building, and organization skills
* Ability to mentor and coach staff
* Ability to lead and motivate staff
* Ability to engage staff at all levels to work toward unified goals and objectives
* Ability to prioritize their work and the work of others to meet rigorous productivity goals and standards
* Ability to present and speak publically
* Ability to use software, hardware and peripherals related to job responsibilities including MS Office
As an Equal Opportunity Employer, the Company will provide equal consideration to all employees and job candidates without regard to sex, age, race, marital status, sexual orientation, religion, national origin, citizenship status, physical or mental disability, political affiliation, service in the Armed Forces of the United States, or any other characteristic protected by federal, state, or local law.
We offer a competitive total compensation and benefits package, an incentive bonus program and an employee recognition program that acknowledges and rewards employees for outstanding performance. Here's a summary of the benefits we offer to MultiPlan employees.
•Medical Dental & Vision Insurance
•Optional and Dependent Life Insurance
•Short and Long-Term Disability
•Paid Time Off
•Paid Company Holidays
•Flexible Spending Account