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HealthPartners · 1 month ago

Credentialing Supervisor

Bloomington, MN

Full-time

Onsite

Mid, Senior Level

2+ years exp

HealthPartners is a nonprofit, integrated health care organization that is currently hiring a Credentialing Supervisor. The role involves overseeing credentialing activities, ensuring compliance with regulatory standards, and managing a team to maintain high-quality credentialing processes.

MedicalPharmaceutical

Responsibilities

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

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

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

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

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

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

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

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

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

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

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

Collects and reports data necessary to monitor the CSB credentialing activities

Acts as resource for Cactus database issues or questions

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

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

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

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

Develops and maintains department training and reference materials

Serves as a resource to staff for credentialing related questions

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

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

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

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

Qualification

NCQA standardsJC standardsCredentialing experienceAnalytical skillsLeadership experienceCommunication skillsTeam collaborationProblem solving

Required

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

Benefits

Health Insurance

Time off

Retirement planning

Continuous learning opportunities

Company

HealthPartners

Glassdoor3.9

HealthPartners, an integrated health care organization providing health care services and health plan financing and administration, was founded in 1957 as a cooperative.

Founded in 2011

Bloomington, Minnesota, USA

10001+ employees