Credentialing Supervisor

Location:  Bakersfield Corporate (CA Ave.)

Job Summary:          

The Credentialing Supervisor is to provide direct credentialing oversight and communication to Omni Family Health (OFH) providers, provider groups, independent contractor providers, and OFH sites ensuring that credentialing processes meet organization, state, federal, and compliance requirements.  This position is responsible to the continued maintenance and oversight of accurate records of provider credentials, ensuring that providers and OFH sites are credentialed with appropriate insurances, plans, and programs.  Meets OFH expectations of timeliness and accuracy of work generated by the Credentialing area.  Oversees process for new and existing provider applications for privileges and reappointments for OFH.  Ensures that privileges and reappointments meet targeted start dates and renewal dates. Monitors licensure renewal activity for all OFH providers. This exempt full-time position oversees the Credentialing Specialists and reports to the Director Human Resources.

 Job Duties & Responsibilities:

  1.  Responsible for working with supervisor to set goals for performance and deadlines in ways that comply with OFH expectations for credentialing area.
  2. Responsible in organizing workflow and ensuring that credentialing specialists understand their duties or delegated tasks
  3. Responsible for monitoring employee productivity and providing feedback and coaching
  4. Oversees process for initial applications and reappointments for OFH provider personnel and independent contractors.
  5. Utilizing credentialing software platform ensures that staff can populate and prepare applications for providers for approval and submission.
  6. Expected to facilitate and Track onboarding paperwork and applications to and from providers by working closely with other areas of Human Resources area (Provider Recruiters & Retention Specialists and Talent Acquisition and Guidance Group).
  7. Ensures proper review of insurance and provider applications for accuracy and completeness.
  8. Oversees staff to ensure that primary source verifications to meet OFH required credentialing standards.
  9. Responsible for ensuring the maintenance of complete and accurate provider credentialing files and documents.
  10. Responsible for the monitoring of providers of upcoming expirable, including expiring privileges, licensures, board certifications, CPR/BLS certification(s), DEA and any other requirements and all other state and federally required documents necessary for the practitioner to legally and ethically perform under their scope of practice.
  11. Ensures that staff communicate to providers of expiring documentation and that staff collect renewal documents.
  12. Ensures that updated documents are noted into systems along with notifications to external plans, programs, and groups occur.
  13. Maintain and update the credentialing database and medical department as provider information and credentials change or renew.
  14. Supports Chief Medical and Chief Dental Officers in the process of credentialing and recredentialing of providers. Ensures that issues and concerns are brought to their attention as discovered in credentialing or recredentialing process.
  15. Establish and maintain professional working relationships with providers and OFH service departments.
  16. Provide weekly status updates to Provider Recruitment Status meeting. Alert the team to any issues or concerns.
  17. Demonstrate exemplary customer service to our providers, departments, and outside contacts.
  18. Meet targeted credentialing deadlines and start dates.
  19. Consistently meet OFH set work standards.
  20. Proficiently use the credentialing system and work with Director of Human Resources on establishment of data performance analytics and overall performance.
  21. Contribute to the advancement and growth of the department.
  22. Various other work-related duties as assigned by supervisor. These duties and responsibilities may be added, deleted, or changed at any time at the discretion of management, formally or informally either verbally or in writing.

 Additional Duties and Expectations for Performance:

  1. As a team member of OFH, respects and protects information regarding patients and other team members and abide by the rules of the OFH Confidentiality Statement Protocol.
  2. Maintains employee confidence and protects operations by keeping provider data and all related materials confidential.
  3. Effectively communicates to Director of Human Resources or their designee, current workload requests and related credentialing area issues as they arise.
  4. Consistently works and greets staff using pleasant demeanor and manner.
  5. Consistently communicates with all staff in a pleasant tone either verbally or when using written communication. 
  6. Remains focused on the goals during periods of conflicting priorities.  Speaks their mind and asks questions to understand.  Expected to request verification from their supervisor in determining work priorities.
  7. Contributes to the team effort by effectively communicating needs to other members of the administrative/fiscal/revenue cycle support staff with whom this position closely works
  8. Works flexible or extended hours where necessary.
  9. Demonstrates awareness of, and compliance with, organizational mission and objective of Omni Family Health to provide health care access and support services for all members of the community.
  10. Complies with Federal, State and Local legal requirements by following developed OFH Human Resources and corporate policies and procedures.
  11. HIPAA compliance – Responsible for maintaining abreast of and in compliance with all HIPAA regulations and requirements. Treats all member information confidential.
  12. Compliance – Ensure compliance with all local, state and federal regulations.
  13. QA/QI – Participate in QA/QI activities and contribute towards the overall performance improvement of the organization.
  14. IT –May be required to learn and use the Electronic Health Record and Practice Electronic System and its components. As required by the job functions and highlighted in the Policies and Procedures. These components include Next Gen, PMS, QSI and other electronic features, as they are developed and implemented, as applicable to work environment.
  15. All employees will participate in Patient Centered Health Home Model at Omni Family Health.

 Qualifications, Education, and Experience:

Educational Requirements:                        

  • High School graduate or equivalent. AS or B.S. degree in business administration or health care related field is a plus.

Experience:               

  • Minimum of five (5) years of supervisory experience.
  • Minimum of three (3) years credentialing or billing experience.  

License/Certification:

  • Certified Provider Credentialing Specialist (CPCS) or Certified Professional Medical Services Management (CPMSM) preferred.

 Skills

  • Knowledgeable in Federal and State Regulation on Confidentiality and Peer Review Guidelines.
  • Have a working knowledge of the credentialing process and requirements.
  • Knowledge of NCQA and/or JCAHO Accreditation standards.
  • Have strong organizational and time management skills.
  • Strong Problem-solving/Analytical Skills
  • Ability to be flexible to change and growth.
  • Ability to work effectively in a fast paced, high volume environment.
  • Strong Customer Service Skills (preferably within a service industry).
  • Skilled in professional verbal, written and email communications.
  • Ability to work effectively with staff, physicians and external customers.
  • Ability to work independently with limited supervision.
  • Communicate professionally with the public.
  • Ability to work independently to consistently execute job responsibilities within a reasonable timeframe.
  • Modern office practices and procedures (including email).
  • Demonstrated Proficiency with MS Office (Outlook, Word, Excel, PowerPoint, and Visio). General computer skills with demonstrated proficiency.
  • Advanced personal organizational skills.

 

 

Responsible to:                      Director of Human Resources

 

Classification:                        Full-time; Non-exempt