Responsible for the daily supervision of the Credentialing staff to ensure work is performed in a manner that meets the standards as set forth in the Credentialing policies and NCQA. Responsible for being a resource for employees and completing assigned daily job duties of the Credentialing Department while maintaining compliance. Ensures recredentialing and projects are completed in a timely manner and meet the standards as set forth in the Credentialing Policies and Procedures and NCQA compliance. Carries out all duties while respecting member and provider confidentiality and promoting the mission and philosophy of the organization supported.
Manages, trains, coaches, develops, and supervises Credentialing team members.
Remains knowledgeable concerning credentialing changes, policies and procedures, and interprets and implements changes accordingly.
Monitors provider credentialing activity and oversees preparation of provider files to be presented to the Board or Credentialing Committee.
Communicates with physician leadership regarding the credentialing status of providers.
Oversees delegated health plan functions and submits improvement plans, as necessary.
Monitors the Texas Medical Board (TMB) website for sanctions and litigation reports and reports findings to Board or Credentialing Committee.
Responsible for the efficient application of the credentialing software.
Adheres to all company policies, including but not limited to, OSHA, HIPAA, compliance and Code of Conduct.
Regular and dependable attendance.
Follows the core competencies set forth by the Company, which are available for review on CMSweb.
OTHER DUTIES AND RESPONSIBILITIES
Performs other duties as assigned.
Education and Experience
Required: High school diploma or GED. Three years of credentialing experience. Two years of supervisory experience.
Preferred: Bachelor’s degree. Previous supervisory experience in a Medical environment preferred. Experience using OneApp preferred.
Knowledge, Skills and Abilities
Knowledge of NCQA credentialing requirements.
Knowledge of National Practitioners Data Bank, TMB sanctions, and TDI application requirements.
Excellent verbal and written communication skills in order to communicate clearly and effectively to all levels of staff and the public.
Ability to sit for extended periods of time at a computer workstation.
Excellent computer skills, including experience in MS Access, MS Excel and MS Word required.
Excellent interpersonal & problem solving skills.
Ability to work in a team environment.
Ability to manage competing priorities.
Ability to analyze problems, make decisions, and manage conflict.
Ability to train and monitor staff to ensure compliance with federal, state and local regulations and established practices; implements new policies/procedures and keeps employees abreast of current changes and standards as they related to business needs.
Certified Professional Credentialing Specialist (CPCS) preferred.
Internal Number: CREDE02670
About Austin Regional Clinic
Austin Regional Clinic is a multispecialty medical group committed to providing comprehensive health care services throughout the greater Austin area. Founded by three physicians in 1980, we now provide healthcare to over 380,000 area residents in 18 locations in six cities, including both primary and specialty care. ARC is unique to the Austin area because of our widespread locations, convenient services and quality assurance programs. Our patients enjoy such conveniences as same-day appointments, daytime urgent care, after hours clinics, and nursing services through the night. Most of our offices also offer on-site radiology and lab services. We have been voted one of the BEST PLACES TO WORK by our employees for 8 years! It's your time to have it all! Watch our video to see what we mean: http://bit.ly/ARCall