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Provider Relations and Credentialing Supervisor

2 months ago

Eden Prairie, Minnesota, United States Volunteers of America National Services Full time

Volunteers of America National Services - PACE is in search of a Provider Relations and Credentialing Supervisor to enhance the Program of All-Inclusive Care for the Elderly (PACE) initiatives across various regions.

Schedule: M-F 8:30 AM-5:30 PM *Remote

Benefit Highlights:

  • 403(b) Retirement Plan
  • Career scholarships;
  • Continuing career education and leadership programs;
  • Dental and Vision Insurance
  • Paid Time Off (Vacation, Holiday & Sick Days)
About the Role

This position oversees external provider/vendor agreements to establish and maintain a reliable, credentialed, and high-quality network of PACE Providers. Ensures adherence to PACE regulations and external standards, including the National Committee for Quality Assurance. Engages in negotiations for service rates in alignment with industry benchmarks and the financial sustainability of the program. Acts as the primary liaison for all contractual matters with service providers.

Key Responsibilities
  • Maintains, with legal oversight, contract and business associate agreement templates for all PACE services, encompassing primary care, specialty care, skilled nursing, and more.
  • Develops and manages relationships with high-quality, cost-effective PACE service providers, including negotiating rates within Medicare and Medicaid guidelines.
  • Continuously monitors the provider market to identify opportunities that enhance service access for participants while meeting diversity goals.
  • Executes agreements for out-of-network services.
  • Ensures timely and compliant credentialing of contracted providers, documenting all necessary credentials as per PACE regulations and industry standards.
  • Maintains comprehensive electronic and manual provider files.
  • Collaborates with the provider relations team to conduct initial and ongoing orientations for providers to ensure compliance with regulations and standards.
  • Facilitates the provision of updated training materials to contracted providers.
  • Works with claims administration to ensure timely and accurate payments to providers.
  • Manages provider directories to keep information current in accordance with PACE regulations.
  • Collaborates with Quality staff to ensure providers meet regulatory and contractual quality standards.
  • Develops policies and procedures related to network development, contract management, and credentialing.
  • Maintains a Provider Database to communicate contract information and updates.
  • Conducts initial credentialing and re-credentialing of providers as required.
  • Performs additional duties as necessary.
Essential Skills
  • Excellent presentation and communication skills, both written and verbal.
  • Strong interpersonal skills.
  • Proficient in Office applications including Outlook, Word, and Excel.
  • Advanced negotiation capabilities.
  • Highly analytical mindset.
  • Ability to manage multiple tasks effectively.
  • Collaborative approach to achieving organizational objectives.
Qualifications
  • Bachelor's degree in a relevant field; Master's degree preferred.
  • A minimum of 5 years of experience in medical contracting, including knowledge of coding, credentialing, and regulatory compliance.
  • Proficient in Office applications including Outlook, Word, and Excel.
  • Experience working with a frail elderly population is preferred.
  • Willingness to travel as needed.
At VOANS, we celebrate diversity and provide equal employment opportunities to all individuals without regard to any characteristic protected by applicable law. We believe that a blend of individual strengths and unique differences fosters an inclusive environment where everyone can thrive.