Accelerated Urgent Care · 2 weeks ago
Contracting & Credentialing Supervisor
Temecula, CA
Full-time
Onsite
Mid, Senior Level
$29.50/hr - $35/hrAccelerated Urgent Care is a fast-growing company recognized as Kern County’s Top Urgent Care center. The Contracting & Credentialing Supervisor is responsible for overseeing provider and facility licensing, credentialing, and contracting, while managing a team of specialists to ensure timely and accurate processes in a rapidly growing organization.
Emergency MedicineHealth CareMedicalPrimary and Urgent Care
Responsibilities
Supervise all essential functions performed by C&C Specialists and C&C Coordinators
Oversee day to day activities of staff who process credentialing and recredentialing applications for health care providers
Daily monitoring of employee’s workload and various credentialing workflows (i.e. onboarding, credentialing, EPCS and e-prescribe, enrollments)
Ensure all C&C tasks and duties have a corresponding Standardized Operating Procedure (SOP)
With guidance from the Billing Manager and Director of Finance, Billing, C&C, interview, hire, and train new staff on credentialing and recredentialing policies and procedures; also provide ongoing training as needed regarding new guidelines or updated processes and policies
Play an important role in making decisions regarding employee’s performance issues such as the need for disciplinary coaching, performance documentation and/or termination
Implement department procedures to facilitate organized and up to date provider databases
Conduct periodic audits of credentialing files and staff deliverables
Administer system for tracking license and certification expirations to ensure renewals are submitted in a timely manner
Monitor external credentialing databases including CAQH, PECOS, and other agencies to ensure data is updated and ready for quick retrieval
Supervise application processes to ensure they are properly verified and accurately uploaded into an online credentialing database system
Resolve complex questions regarding credentialing or provider database maintenance and best practices
Prepare and/or oversee reports on applications and credentialing statuses to identify trends and improve the credentialing process
Supervise all provider and facility licensing, credentialing, and contracting necessary to ensure claims are paid and cash flow is not disrupted
Develop and oversee licensing, credentialing, and contracting workflows and processes as we scale our clinical team across California and potentially other states
Supervise maintenance and accuracy of tracking databases of required provider and facility licenses, certifications, contract statuses, and credentials; in addition, review critical data and the associated documents on an ongoing basis to ensure compliance
Supervise C&C Specialists/Coordinators to ensure AUC’s provider roster to mitigate risks associated with growth, drive efficiencies, and advance proactive monitoring and action related to licensing, credentialing, and contracting
Oversee and communicate provider and plan statuses, along with barriers related to operational processes, and drive solutions to overcome challenges
Ensure contracting and credentialing support is readily provided to various departments, teams, and individuals within the organization as needed to fulfill business needs
Partner with various health plan representatives to promptly follow up and execute provider and plan approval dates
Track and monitor all executed health plan agreements, work with the Billing Manager to ensure claims are billed correctly per the executed agreements
Work directly with the Billing Manager to ensure new health plan contracts and their associated effective dates are communicated to the appropriate Operations Managers for staff notification and education purposes
Oversee the communication of new providers as they are onboarded to the Billing Team, to ensure claim reimbursements are maximized
Supervise new provider credentialing which includes sending welcome emails to new providers, in addition be of assistance for any questions or concerns they may have. Trouble shoot barriers quickly to avoid delays in receiving credentialing approvals
Supervise the professional liability application process, ensure the application and approval process is efficient and timely
Oversee the Supervising Physician matrix along with the associated agreements, to remain in compliance with the Medical Board and health plan requirements
Oversee submission of Letters of Intent to health plans or medical groups that we are not yet contracted with; educate and build relationships with health plan groups to help expedite the contracting process
Supervise the contracting and credentialing of all new facilities, to ensure new clinics are contracted by their assigned go live date
Perform special projects and other duties as requested
Perform other duties as assigned
Comply with departmental policies and procedures
Responsible for showing up to work on time and being available to all team members including HR, Billing, and Providers during work hours
Work well with all AUC staff members
Provide personal commitment and ownership to enhance knowledge, skills, and abilities in healthcare contracting, credentialing, and compliance
Maintain patient confidentiality and information security, adhere to all HIPAA regulations and requirements
Follow and adhere to CDC requirements for healthcare facilities
Qualification
Required
Supervise all essential functions performed by C&C Specialists and C&C Coordinators
Oversee day to day activities of staff who process credentialing and recredentialing applications for health care providers
Daily monitoring of employee's workload and various credentialing workflows (i.e. onboarding, credentialing, EPCS and e-prescribe, enrollments)
Ensure all C&C tasks and duties have a corresponding Standardized Operating Procedure (SOP)
With guidance from the Billing Manager and Director of Finance, Billing, C&C, interview, hire, and train new staff on credentialing and recredentialing policies and procedures; also provide ongoing training as needed regarding new guidelines or updated processes and policies
Play an important role in making decisions regarding employee's performance issues such as the need for disciplinary coaching, performance documentation and/or termination
Implement department procedures to facilitate organized and up to date provider databases
Conduct periodic audits of credentialing files and staff deliverables
Administer system for tracking license and certification expirations to ensure renewals are submitted in a timely manner
Monitor external credentialing databases including CAQH, PECOS, and other agencies to ensure data is updated and ready for quick retrieval
Supervise application processes to ensure they are properly verified and accurately uploaded into an online credentialing database system
Resolve complex questions regarding credentialing or provider database maintenance and best practices
Prepare and/or oversee reports on applications and credentialing statuses to identify trends and improve the credentialing process
Supervise all provider and facility licensing, credentialing, and contracting necessary to ensure claims are paid and cash flow is not disrupted
Develop and oversee licensing, credentialing, and contracting workflows and processes as we scale our clinical team across California and potentially other states
Supervise maintenance and accuracy of tracking databases of required provider and facility licenses, certifications, contract statuses, and credentials; in addition, review critical data and the associated documents on an ongoing basis to ensure compliance
Supervise C&C Specialists/Coordinators to ensure AUC's provider roster to mitigate risks associated with growth, drive efficiencies, and advance proactive monitoring and action related to licensing, credentialing, and contracting
Oversee and communicate provider and plan statuses, along with barriers related to operational processes, and drive solutions to overcome challenges
Ensure contracting and credentialing support is readily provided to various departments, teams, and individuals within the organization as needed to fulfill business needs
Partner with various health plan representatives to promptly follow up and execute provider and plan approval dates
Track and monitor all executed health plan agreements, work with the Billing Manager to ensure claims are billed correctly per the executed agreements
Work directly with the Billing Manager to ensure new health plan contracts and their associated effective dates are communicated to the appropriate Operations Managers for staff notification and education purposes
Oversee the communication of new providers as they are onboarded to the Billing Team, to ensure claim reimbursements are maximized
Supervise new provider credentialing which includes sending welcome emails to new providers, in addition be of assistance for any questions or concerns they may have. Trouble shoot barriers quickly to avoid delays in receiving credentialing approvals
Supervise the professional liability application process, ensure the application and approval process is efficient and timely
Oversee the Supervising Physician matrix along with the associated agreements, to remain in compliance with the Medical Board and health plan requirements
Oversee submission of Letters of Intent to health plans or medical groups that we are not yet contracted with; educate and build relationships with health plan groups to help expedite the contracting process
Supervise the contracting and credentialing of all new facilities, to ensure new clinics are contracted by their assigned go live date
Perform special projects and other duties as requested
Perform other duties as assigned
Comply with departmental policies and procedures
Responsible for showing up to work on time and being available to all team members including HR, Billing, and Providers during work hours
Work well with all AUC staff members
Provide personal commitment and ownership to enhance knowledge, skills, and abilities in healthcare contracting, credentialing, and compliance
Maintain patient confidentiality and information security, adhere to all HIPAA regulations and requirements
Follow and adhere to CDC requirements for healthcare facilities
Benefits
Medical
Dental
Vision
Life
PTO
Stocked Coffee Bar
Company
Accelerated Urgent Care
Accelerated Urgent Care is a health care company that provides patients and their families care.
Founded in 2004
201-500 employees
Funding
Current Stage
Growth StageLeadership Team
Angela Barton
Chief Marketing and Public Relations Officer
Company data provided by crunchbase