Our Mission: Provide the best value in health insurance and related health services to improve the quality of life for Arizonans.
Inspire health in Arizona as the trusted leader in delivering affordable, innovative healthcare solutions.
Our Benefits: Our benefits provide work-life balance and the flexibility you need to be your best. We offer comprehensive medical, dental, and vision coverage; a 401K savings plan; paid holidays and vacations; and much more!
Position Purpose: Reporting to the Director of Credentialing, Credentialing Supervisor oversees and coordinates daily team operations.
- Manages, coordinates, and organizes all aspects of credentialing and recredentialing activities for practitioners and facilities in accordance with AHCCCS, CMS, and NCQA guidelines.
- Oversight responsibilities include management of Credentialing Department Staff to ensure overall department objectives and goals are met or exceeded.
- Establishes, implements, and monitors performance goals, metrics, and processes for the Credentialing department.
- Prepares and maintains various reports, data, and summaries of credentialing activities for monthly organizational review and quarterly AHCCCS reporting.
- Manages the credentialing process to ensure policies, workflows, and desktop procedures are adhered to by Credentialing Department Staff. Identifies and implements opportunities for improvement.
- Reviews Credentialing policies, workflows, desktop procedures, and training materials at least annually. Ensures materials adhere to accreditation and regulatory guidelines.
- Independently troubleshoots issues as they arise.
- Coordinates and manages the health plan Credentialing Committee(s).
- Coordinates and ensures compliance with credentialing delegation oversight. Notifies leadership of new groups wishing to become delegated and partners with Credentialing Department Staff to conduct pre-delegated and annual evaluations.
- Develops partnerships with relevant internal and external staff. Takes action to improve based on discussions with internal partners. Participates in monthly Delegated JOC meetings with Network Operations Team.
- Maintains a calendar of activities relative to the timely performance of delegated oversight auditing. Follows up with Credentialing Department Key Staff to ensure outreach to delegates is completed when due and review of files is conducted as they are received. Ensures delegation activities are adequately summarized and reported to the Credentialing Committee. Effectively communicates issues with delegation files with leader and notifies Compliance Department when corrective action is required.
- Maintains ongoing participation in cross-training activities, ensures appropriate staff training and coverage for incoming volume. Actively engages in addressing special projects as they arise. Provides valid feedback to the Credentialing Director on departmental issues and progress.
- Other duties as assigned.
Education / Experience / Other Requirements
- Bachelor’s degree in a related field (or equivalent combination of education and experience)
- CPCS or CPMSM Certification required within one year of hire (within three years of hire for applicants without prior credentialing/recredentialing experience)
Years of Experience:
- A minimum of five years of relevant experience in healthcare related environment, preferably with experience in a credentialing/recredentialing environment with knowledge of several sets of national accreditation or regulatory criteria.
- Microsoft Office software (Outlook, Word, Access, Excel, PowerPoint)
- Previous symplr (eVIPs/CACTUS), MSOW, or MD-Staff credentialing database experience strongly preferred.
- Previous Managed Care and/or Medicaid experience strongly preferred.
- Ability to analyze and evaluate data and other provider related problems to develop alternative solutions for a positive outcome.
- Ability to multi-task and prioritize workload, manage multiple priorities, and pay meticulous attention to detail.
- Thorough understanding of managed care principles and physician practice operations, with an understanding of health plan provider enrollment and credentialing preferred.
- Excellent organizational skills, proven project management expertise; Strong verbal and written communication skills.
- Outstanding interpersonal skills, able to quickly establish a trusting rapport with individuals at all levels.
- Requisite poise, judgment, and trustworthiness to represent HCA to internal and external groups.
- Maintains information in a confidential manner according to policy.