Supervisor Credentialing
Cambia Health

SUPERVISOR CREDENTIALING (HEALTHCARE)

Telecommute Option - Must reside in ID, OR, UT or WA


WHO WE NEED

This person supervises the credentialing team and acts as a resource for the credentialing staff. The role is accountable for planning, directing, and overseeing the credentialing process for providers and staff across all health insurance plans. Oversees and coordinates team activities to achieve business objectives, meet or exceed performance standards and service level goals.

Preferred Key Experience:

• Certification as a Certified Professional in Medical Services management (CPMSM) or Certified Provider Credentialing Specialist (CPCS) preferred.
  
• At least six years of credentialing experience or other related work.
  
• Presentations skills - large groups including Leadership, attorney's, medical directors, etc.
  
• Time Management and Prioritization Skills
  

Normally to be proficient in the competencies listed above

Supervisor Credentialing would have:

• Bachelor's degree
  
• 6 years of experience in credentialing
  
• 5 year project work
  
• 2 years of leadership experience (Lead/SR Level acceptable)
  
• Or equivalent combination of education and experience.
  

FTEs Supervised

10-15 employees

YOUR ROLE:

• Assigns and prioritizes work, sets goals, and coordinates daily activities of the team. Provides regular updates and communication to staff through 1:1 and team meetings.
  
• Monitors individual and team results to ensure work is completed in a timely manner, in accordance with department standards and procedures, and is in compliance with medical policy and medical necessity guidelines.
  
• Analyzes data of work performed by individuals, team and other teams and develops action plans based on the data.
• Assists in development of productivity and quality standards. May conduct or participate in compliance audits and report audit findings. Identifies and implements process improvements as needed consistent with organizational goals.
• Acts as a resource for staff and others. Appropriately escalates issues and partners with other departments to resolve issues and remove barriers.
• Participates in the hiring process, provides on-going coaching, employee development, performance improvement and writing of performance reviews. Develops and maintains desk reference guides on work procedures. Ensures new hires complete necessary training. Assesses training needs and plays an active role in development of staff.
• Completes special projects as assigned and may provide back-up support to staff as needed.
• Oversees the termination and appeals process for practitioners and organizational providers.
• Oversees the negotiation of credentialing and re-credentialing disputes with providers and facilities.
• Represents the medical services team on corporate project team to implement new products, providers networks, product modifications and administrative changes.
• Develops and implements approved policies, procedures and forms for the credentialing and re-credentialing process according to NCQA, HCFA, URAC, state and federal standards and applicable contract requirements.

WHAT YOU BRING:

• Extensive knowledge of the regional health care provider community, current state and federal legislation and credentialing and contracting protocol, including primary source verification and NCQA (National Committee on Quality Assurance) and URAC requirements.
  
• Demonstrated knowledge in provider contracting and credentialing processes, managed care principles, operations and system requirements.
  
• Demonstrated competency in setting priorities for a team and overseeing work outputs and timelines.
• Ability to communicate effectively, verbally and in writing including with members, employer or provider groups.
• Ability to effectively develop and lead a team (including employees who may be in multiple locations or work remotely).
• Demonstrated experience in recognizing problems and effectively resolving complex issues.
• Ability to apply best practices and designated standards.

The expected target hiring range for this position is $82.4k - $111k depending on skills, experience, education, and training; relevant licensure / certifications; performance history; and work location. The bonus target for this position is 10%. The current full salary range for the Supervisor Membership is $77k Low Range / $97k MRP / $127k High Range,.

Base pay is just part of the compensation package at Cambia that is supplemented with an exceptional 401(k) match, bonus opportunity and other benefits. In keeping with our Cause and vision, we offer comprehensive well-being programs and benefits, which we periodically update to stay current. Some highlights:

• medical, dental, and vision coverage for employees and their eligible family members
  
• annual employer contribution to a health savings account ($1,200 or $2,500 depending on medical coverage, prorated based on hire date)
  
• paid time off varying by role and tenure in addition to 10 company holidays
  
• up to a 6% company match on employee 401k contributions, with a potential discretionary contribution based on company performance (no vesting period)
  
• up to 12 weeks of paid parental time off (eligible day one of employment if within first 12 months following birth or adoption)
  
• one-time furniture and equipment allowance for employees working from home
  
• up to $225 in Amazon gift cards for participating in various well-being activities. for a complete list see our External Total Rewards page.
  

We are an Equal Opportunity and Affirmative Action employer dedicated to workforce diversity and a drug and tobacco-free workplace. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, age, sex, sexual orientation, gender identity, disability, protected veteran status or any other status protected by law. A background check is required.

If you need accommodation for any part of the application process because of a medical condition or disability, please email CambiaCareers@cambiahealth.com. Information about how Cambia Health Solutions collects, uses, and discloses information is available in our Privacy Policy. As a health care company, we are committed to the health of our communities and employees during the COVID-19 pandemic. Please review the policy on our Careers site.

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