Credentialing Supervisor
4 weeks ago
Nova Southeastern University is seeking a highly skilled Credentialing Supervisor to join our team. The successful candidate will be responsible for planning, directing, and coordinating work activities of subordinates and staff, including hiring, coaching, evaluating, and terminating, all in accordance with university policies and procedures.
Key Responsibilities:- Conduct thorough background investigations and research of application files
- Complete provider credentialing and re-credentialing applications
- Monitor applications and follow-up with respective agencies and/or third-party payers to ensure compliance
- Perform credentialing of faculty and professional staff with Medicare, Medicaid, HMO, PPOs, and other 3rd party carriers to ensure providers are contracted
- Maintain up-to-date data for each provider in databases and online systems as it relates to education, training, licensing, and experience to ensure practice addresses are current with health plans, agencies, and other entities
- Apply for Provider's Hospital Privileges and ensure timely and accurate treatment
- Drive and implement seamless protocols for gathering credentialing data from health care providers
- Assist in the development and implementation of process improvement initiatives
- Participate in the development of policies and procedures
- Track license and certification expirations for providers to ensure timely renewal
- Maintain provider credential files securely and provide support for college review committees
- Keep up-to-date on new policies and procedures from third-party payers and communicate with staff
- Ensure interpretation and compliance with the appropriate accrediting and regulatory agencies
- Assist with managed care delegated credentialing audits and conduct internal file audits
- Respond to inquiries from other healthcare organizations and interface with internal and external customers on day-to-day credentialing and privilege issues
- Participate in contracting functions and understand contract terms
- Complete other projects as assigned
Requirements:
- Associate degree or sixty (60) completed college credits hours
- Minimum five (5) years of credentialing and/or contracting experience
- Prior supervisory experience
- Experience with credentialing software
- Certified Provider Credentialing Specialist (CPCS)
Preferred Qualifications:
- Experience with credentialing and/or insurance contracting in a medical setting
Is this a safety-sensitive position? No
Background Screening Required? Yes
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