Credentialing Supervisor

Summary

Join Specialty1 Partners as a Credentialing Supervisor and oversee the end-to-end credentialing process for all healthcare providers. Lead and develop a high-performing credentialing team, ensuring compliance with all relevant standards and regulations. Develop and improve credentialing processes, policies, and procedures. Collaborate with stakeholders and internal departments to align credentialing processes with organizational goals. Leverage technology to streamline processes and maintain records. This remote position offers a competitive salary and a comprehensive benefits package.

Requirements

• Bachelor's Degree Healthcare Administration, Business, or related field
• 6 Years Relevant experience in lieu of a degree
• 8+ years progressive experience in provider payor enrollment, credentialing, and privileging processes
• 4+ years of leading and developing high performing teams
• Detailed understanding of Medicare, Medicaid, and Managed Care Plan regulations
• Experience with credentialing platforms, related software, and websites (NPPES, CAQH, etc.)
• Goal Driven with a firm understanding of credentialing department KPIs
• Must be able to work under pressure and meet deadlines, while maintaining a positive attitude and providing exemplary customer service
• Ability to multi-task and align priorities accordingly

Responsibilities

• Oversee the end-to-end credentialing process for all healthcare providers
• Lead the credentialing team, cultivating a work environment that encourages teamwork, professional growth, and adherence to annual performance goals and metrics while focusing on delivering value to the company
• Develop, Implement, and continuously improve credentialing, recredentialing, and privileging processes, policies, and procedures to ensure compliance with regulatory requirements
• Audit and assess the effectiveness and efficiency of credentialing end-to-end processes
• Ensure compliance with and stay abreast of changes to legal and regulatory standards with the National Practitioner Data Bank
• Collaborate with relevant stakeholders on mutual topics of interest; provide updates on changes regarding enrollment and credentialing. Specifically, participate in Payor meetings, and collaborate with RCM on credentialing and enrollment related claims projects and denials
• Collaborate with internal departments, such as Human Resources, and Quality and Compliance to ensure alignment of credentialing processes with organizational goals and objectives
• Leverage technology platforms and software systems to streamline the credentialing processes, maintain records, and enhance efficiency

Preferred Qualifications

Dental experience

Benefits

• BCBS High Deductible & PPO Medical insurance Options
• VSP Vision Coverage
• PPO Dental Insurance
• Complimentary Life Insurance Policy
• Short-term & Long-Term Disability
• Pet Insurance Coverage
• 401(k) plan
• HSA / FSA Account Access
• Identity Theft Protection
• Legal Services Package
• Hospital/Accident/Critical Care Coverage
• Paid Time Off
• Diverse and Inclusive Work Environment