Credentialing Supervisor

Description

GI Alliance is seeking an experienced Credentialing Supervisor .

Duties of this position include, but are not limited to, the following:

Position purpose

Responsible for the oversight of the credentialing and recredentialing application process for health care providers with all health plans. The position is also responsible for ensuring compliance with credentialing guidelines for NCQA and understanding the credentialing processes for each of the health plans GI Alliance is contracted with. The Credentialing Supervisor will assist the Payor Operations AVP with implementing new providers and ensure credentialing activities are complete prior to their effective date with GI Alliance. This position will assist with developing credentialing policies and implementation of delegated credentialing.

Responsibilities/Duties/Functions/Tasks

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Develop and refine internal credential processes as needed.
• Develop workflows and standard operating procedures as needed.
• Assist with implementation of credentialing processes and policies
• Actively track risks and issues and drive progress towards resolution.
• Ensure providers credentialing is completed prior to the effective date with the health plans.
• Assist with training and educating credentialing staff and provider offices on credentialing processes.
• Assist Payor Operations AVP as needed for any escalated issues
• Compile and maintain current and accurate data for all providers.
• Complete provider credentialing and recredentialing applications; monitors applications and follow-ups as needed.
• Ensure credentialing staff are maintaining appropriate copies of current state licenses, DEA certificates, malpractice coverage and any other required credentialing documents for all providers.
• Maintain knowledge of current health plan and agency requirements for credentialing providers to include the delegated credentialing process.
• Set up and maintains provider information in online credentialing databases and system.
• Track license and certification expirations for all providers to ensure timely renewals.
• Ensure the data accuracy of practice demographics, to include addresses, phone numbers, fax numbers, etc. are current with health plans, agencies and other entities
• Administrative duties include approving payroll, time-off requests, etc.
• Provide employee feedback, coaching, and counseling to employees as needed including conducting annual employee performance reviews
• Other duties as assigned.
  
  

Qualifications

Qualifications

Education: High school diploma or equivalent.

Experience: Minimum of seven 7) to ten (10) years of credentialing experience preferred.

Additional Qualifications: N/A

Performance Requirements

• Strong presentation skills.
• Excellent communication skills, both written and verbal.
• Ability to work with physicians and non-physician providers.
• Proficient technical (computer) skills.
• Ability to multi-task and prioritize.
• Self-motivated with initiative.
• Strong sense of ethics.
  
  

GI Alliance is an Equal Opportunity Employer. We are committed to creating an inclusive, welcoming, and equitable work environment. Our company values and celebrates the diversity of our physicians, staff and patients. We firmly believe our service is greatly enriched by our diversity of thought, experience, perspective, culture, and background.

Please Note: All job offers are contingent on the successful completion of pre-employment criminal history check.

NOTE: ALL APPLICATIONS MUST BE COMPLETED IN FULL FOR CONSIDERATION.

No phone calls or agencies, please.

EEO/AA-M/F/disabled/protected veteran