Credentialing Operations Team Lead / Supervisor
At Claritev, we pride ourselves on being a dynamic team of innovative professionals. Our purpose is simple – we strive to bend the cost curve in healthcare for all. Our dedication to service excellence extends to all our stakeholders – internal and external – driving us to consistently exceed expectations. We are intentionally bold, we foster innovation, we nurture accountability, we champion diversity, and empower each other to illuminate our collective potential.
Be part of our amazing transformational journey as we optimize the opportunity towards becoming a leading technology, data, and innovation voice in healthcare. Onward and Upward!!!
JOB SUMMARY
Provide leadership, direction and back up support to staff responsible for functional activities related to initial credentialing and recredentialing of the Claritev Provider Networks. .
DUTIES
- Ensure all (re)credentialing processes are in compliance with NCQA accreditation standards in an effort to maintain accreditation by effectively and efficiently managing department activities.
2. Credentialing
* Oversee operational processes cycle in support of staff, time and quality objectives for (re)credentialing to meet NCQA requirements and additionally in support of all Claritev, Beech and HEOS networks.
* Manage recredentialing of non-respondent inventories.
3. Policy Management –Assure compliance of staff for all applicable policies and procedures and contribute regularly to maintaining all updates to all policies impacting the Credentialing Operations business unit(s).
4. Reporting & Data Integrity — Produce reporting for staff productivity auditing for data integrity and coordinating results with management for departmental reporting.
5. Training –Identify training needs for staff surrounding the credentialing and recredentialing process as well as the delivery of NCQA related training.
6. Project Management –Collaborate on projects according to the needs of the department and in support of corporate objectives acting as a subject matter expert (SME) for (re)credentialing operation information, processes and procedures.
7. Technical Skill — Experience in using Microsoft suite of products including Excel and Access to manage large data sets and analyze complex business scenarios
8. Select, develop, and evaluate staff to ensure the efficient operation of department.
9. Collaborate and communicate across disciplines and departments.
10. Ensure compliance with HIPAA regulations and requirements.
11. Demonstrate commitment to the Company’s core values.
12. Responsible for routine internal monitoring and auditing of compliance risks, prompt response to compliance issues as they are raised, investigation of potential compliance problems as identified in the course of self-evaluation and audits, correction of such problems promptly and thoroughly to reduce the potential for recurrence as required by applicable state and federal laws, regulations and MPI’s Compliance Programs
13. The position responsibilities outlined above are in no way to be construed as all encompassing. Other duties, responsibilities, and qualifications may be required and/or assigned as necessary.
JOB SCOPE:
The incumbent works under limited supervision, leading and motivating a remote worker team that is primarily focused on credentialing and recredentialing of the Claritev Provider Networks. The incumbent must use independent judgment to identify issues, trends and possible problems and recommend action plans to address. The incumbent must be able to balance several projects at a time that may be varied or complex, while maintaining a focus on achieving all department goals for quality and service. This is a management position overseeing direct reports. Responsibilities may include some budgetary functions. 45 percent of overall responsibilities are dedicated to Quality Management (QM) functions which consist of collaborating with management to identify, develop and support quality and training improvements.
COMPENSATION
The salary range for this position is $55-70K. Specific offers take into account a candidate’s education, experience and skills, as well as the candidate’s work location and internal equity. This position is also eligible for health insurance, 401k and bonus opportunity.
Qualifications
REQUIREMENTS
* Minimum Bachelor’s degree, or 3 years of related operations and/or credentialing experience
* Minimum 3 years of experience in related managed healthcare environment including minimum 3 years of project management and supervisory experience
* Required licensures, professional certifications, and/or Board certifications as applicable
* Active or actively pursuing Certified Provider Credentialing Specialist (CPCS) certification
* Knowledge of accreditation standards related to NCQA, and state regulatory agencies, websites and resources
* Knowledge of the Company’s data systems and a familiarity with Imaging/Workflow Environment; ECHO database systems; Provider Data Management processes (Registrar, Cred/ReCred, Demographics, rates) and Service Operations desirable.
* Knowledge of departmental processes and its relationship with organizational objectives and outcomes.
* Communication (oral, written and listening), prioritization, organizational, project and process management, leadership and team building skills
* Ability to lead, motivate and mentor individuals and teams
* Ability to serve as a subject matter expert (SME) on regulatory compliance and credentialing requirements
* Ability to negotiate and coordinate activities of individuals and groups
* Ability to effectively manage resources and workflow for multiple projects simultaneously, including a diverse remote work team, ensuring all inventory and processing standards are being met
* Ability to use software, hardware and peripherals related to job responsibilities including MS Office
* Ability to manage operations in a date driven environment
* Ability to work with and understand complex data systems
* Ability to focus on results and successful achievement of business objectives
* Ability to take action independently by gathering information, identifying tasks and following through
* Ability to collaborate with others to ensure best practices are explored, implemented and shared
* Ability to develop and maintain cooperative relationships at all levels of organization by sharing information
BENEFITS
We realize that our employees are instrumental to our success, and we reward them accordingly with very competitive compensation and benefits packages, an incentive bonus program, as well as recognition and awards programs. Our work environment is friendly and supportive, and we offer flexible schedules whenever possible, as well as a wide range of live and web-based professional development and educational programs to prepare you for advancement opportunities.
Your benefits will include:
- Medical, dental and vision coverage with low deductible & copay
- Life insurance
- Short and long-term disability
- Paid Parental Leave
- 401(k) + match
- Employee Stock Purchase Plan
- Generous Paid Time Off – accrued based on years of service
- WA Candidates: the accrual rate is 4.61 hours every other week for the first two years of tenure before increasing with additional years of service
- 10 paid company holidays
- Tuition reimbursement
- Flexible Spending Account
- Employee Assistance Program
- Sick time benefits – for eligible employees, one hour of sick time for every 30 hours worked, up to a maximum accrual of 40 hours per calendar year, unless the laws of the state in which the employee is located provide for more generous sick time benefits
EEO STATEMENT
Claritev is an Equal Opportunity Employer and complies with all applicable laws and regulations. Qualified applicants will receive consideration for employment without regard to age, race, color, religion, gender, sexual orientation, gender identity, national origin, disability or protected veteran status. If you would like more information on your EEO rights under the law, please click here.
APPLICATION DEADLINE
We will generally accept applications for at least 5 calendar days from the posting date or as long as the job remains posted.
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