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Partnership HealthPlan of California · 2 days ago

Credentialing Supervisor

Fairfield, CA

Full-time

Onsite

Mid, Senior Level

$94K/yr - $117K/yr

3+ years exp

Partnership HealthPlan of California is seeking a Credentialing Supervisor to oversee the credentialing functions of the organization. This role involves supervising staff, ensuring accuracy and timeliness in credentialing processes, and providing leadership and training to the team.

Health CareInsuranceNon Profit

Culture & Values

Responsibilities

Supervise the daily functions of the PR Credentialing staff processing credentialing and re-credentialing applications for medical providers and organizations according to National Committee for Quality Assurance (NCQA) standards

Provide leadership, direction, training, and support to staff

Monitor staff productivity, accuracy, and service delivery using performance standards

Provide monthly performance feedback to staff

Evaluate needs and conduct or arrange staff trainings

Monitor inventory control reports weekly and adjust staff priorities based on inventory

Produce bi-weekly inventory and aging reports

Support staff development by identifying applicable training opportunities and training staff on new and challenging duties

Conduct annual performance evaluations

Monitor ACD phone usage and issue daily/weekly reports

Interview and participate in selection of PR staff that will directly report to Supervisor

Responsible for cross training; ensuring at least two staff can perform each function

Participate in Partnership audits, internal and external. Prepare documentation and participate in special projects and assignments

Ensure timelines and due dates are met

Attend Partnership Credentialing Committee. Oversee the quality of materials presented at Credentialing meetings, ensuring agendas, supporting documents, and minutes are prepared timely and accurately

Responsible for credentialing delegation oversight. Ensure that delegated entities submit required documents on schedule and follow-up as required

Oversee timely audits of delegated credentialing activities

Ensure Credentialing policies are updated and in compliance with DHCS and NCQA requirements

Ensure desktop procedures are up-to-date

Promote a positive attitude, team work, and fun in the workplace

Qualification

Healthcare experienceCredentialing knowledgeNCQA standards knowledgeBachelor’s degreeSupervisory experienceMedi-Cal policiesBusiness software applicationsJudgmentCommunication skillsOrganization skillsDecision-making

Required

Bachelor's degree in Healthcare, Business, or related field

Minimum three (3) years of experience in healthcare, credentialing, or provider relations

Equivalent combination of education and experience

Working knowledge of NCQA credentialing standards, credentialing practices, Medi-Cal managed care and business software applications

Ability to implement Medi-Cal policies and procedures

Valid California driver's license and proof of current automobile insurance compliant with Partnership policy

Excellent oral and written communication skills

Excellent organization skills with the ability to prioritize assignments, maintain accurate records, and meet deadlines

Ability to use good judgment in making decisions within scope of authority and handle sensitive issues with tact and diplomacy

Ability to use a computer keyboard

Ability to move, carry, or lift objects of varying size, weighing up to 35 lbs

Preferred

Previous supervisory experience a plus

Knowledge of medical providers and credentialing requirements

Company

Partnership HealthPlan of California

Partnership HealthPlan of California is a non-profit community-based health care organization that contracts with the state to administer Medi-Cal benefits through local care providers to ensure Medi-Cal recipients have access to high-quality comprehensive cost-effective health care.

Founded in 1994

Fairfield, California, USA

1001-5000 employees