Credentialing Supervisor

HealthPartners is hiring a Credentialing Supervisor. The Credentialing Supervisor is responsible to implement, coordinate and evaluate all aspects of credentialing activities within the HealthPartners Credentialing Services Bureau, and support the management of credentialing, re-credentialing and privileging activities.

To ensure compliance with applicable regulatory laws, rules, regulations, NCQA and Joint Commission accreditation standards and other internal or external customer requirements regarding the CSB aspects of credentialing and privileging.

ACCOUNTABILITIES:

1. Knowledgeable of regulatory, accreditation and other external customer requirements regarding credentialing including, but not limited to NCQA, JC, and CMS.

2. Responsible to assist the Director and Manager to ensure credentialing processes are in compliance with NCQA, JC, MN Department of Health and CMS.

3. Responsible for the supervision, recruitment, orientation, training, development, and day-to-day management of assigned staff.

4. Assists the CSB Quality Assurance Coordinators (QAs) in reviewing and auditing of all completed practitioner files ensuring that all necessary elements are present and correct in the file according to corporate, accreditation, regulatory and department standards. Determines if all file and data criteria is met. Records on tracking mechanisms.

5. Works collaboratively with QAs to ensure the highest standards of quality and accuracy of the credentialing process.

6. Assists the QAs in reviews and audits of data entry of practitioner data in the credentialing database and records results on tracking reports to ensure accuracy, completeness and adherence to established quality standards.

7. Reviews records and identifies barriers that encumber desired credentialing results. Develops and implements plans to remove the barriers to achieve highest level of performance.

8. Provides mentoring to CSB staff in performing departmental tasks and plans the appropriate course of action for situations not covered by policies and procedures under the direction of the Director. Assists in day-to-day mentoring and coaching.

9. Supports the credentialing process which may include tracking, reporting and creating of new procedures and/or policy creation.

10. Participates in activities to develop and improve materials, policies, and procedures to support day-to-day operations.

11. Participates in activities that support development of database program to assist in the credentialing process.

12. Collects and reports data necessary to monitor the CSB credentialing activities.

13. Acts as resource for Cactus database issues or questions.

14. Works closely with Manager and Director to develop and deliver scheduled in-services and training documentation.

15. Conducts audits and works with Credentialing Manager and Director on a variety of credentialing issues to facilitate quality assurance efforts

16. Leads improvement processes by identifying trends, recurring issues and communication problems.

17. Suggests new processes and/or change to existing process and/or policy and procedure.

18. Develops and maintains department training and reference materials.

19. Serves as a resource to staff for credentialing related questions.

20. Provides day to day operational support, direction and leadership to assigned staff, including problem solving.

21. Provides administrative leadership to the CSB staff in the Manager or Director's absence. This includes providing direction, making appropriate judgment decisions, assuring that there is appropriate staffing in the CSB, coordinating and facilitating staff meetings, etc.

22. Remains current with credentialing requirement mandated by external review agencies (e.g., NCQA, JC, and/or state and federal regulations). Works with Manager and Director to modify processes to ensure compliance with such requirements.

23. Performs other projects and/or duties as assigned by Manager or Director.

    REQUIRED QUALIFICATIONS:

• Bachelor's Degree and two years managed care or health care setting credentialing experience, or high school diploma/GED and five years managed care or health care setting credentialing experience.

• Knowledge of and experience dealing with implementing NCQA or JC credentialing standards.

• Minimum of one-year leadership experience.

• Analytical skills required to analyze and interpret data into meaningful reports.

• Ability to work with multiple departments and organizations to deliver results.

• Strong communication skills, verbal and written.

DECISION-MAKING:

• Supervisor is expected to perform independently on a day to day basis within the scope of accountabilities.

• Provide leadership to CSB staff in making appropriate departmental policy decisions and plan the appropriate course of action for situations not covered by policies and procedures, in the absence of the Manager or Director.

• Independently coordinate Medical Director or legal review when appropriate.

• Responsible for the personnel decisions regarding supervisor's direct reports (Local 12 staff).