Coordination and supervision of CVO managed care credentialing process and staff:

·        Provides supervision and evaluation of assigned Provider Enrollment credentialing staff, assigns credentialing files and projects, and ensures timely file processing and credentialing submissions to health plans and payors.

·        Oversees daily operations of provider enrollment.

·        Provides mentoring, training, and education to staff. Acts as an educational resource and is available for consultation to departmental staff. Provides backup resources for staff.

·        Responsible for accurate and complete data entry of credentialing/enrollment information into credentialing database.

·        Works with database support staff to ensure updates are implemented.

·        Summarizes provider information and completes the UTP Credentials reporting grid for Credentials Committee.

·        Assures compliance with NCQA Standards, State and Federal requirements, health plan delegation agreements, and department policies.

·        Maintains knowledge of NCQA, CAQH, and CMS standards.

·        Maintains and tracks a list of new providers in credentialing process via spreadsheet distributed to UT Faculty.

·        Completes audit of signed enrollment applications and required documentation for completeness and accuracy.

·        Coordinates and facilitates troubleshooting with Revenue Cycle team to resolve any issues related to credentialing and associated billing and collections of revenue.

·        Oversees staff responsible for notification process for UTP Department Billing Coordinators and appropriate staff to initiate charge entry and release of charges.

·        Review and update UTP policies and procedure as needed in accordance with NCQA standards. Evaluate, implement and maintain process, policies and procedures.

·        Responsible for the oversight of submission or comprehensive rosters and reports to delegated plans according to the requirements of the delegation agreement.

·        Oversight and monitoring of CAQH online credentialing database.

Delegated Plan Audit Process:

·        Oversee and support Health Plan desktop audit process for the UTP delegated plans.

·        Oversee and support biennial NCQA accreditation survey process.

·        Provide support and guidance for providers being submitted to UTP Credentials Committee to ensure files are complete accurate and submitted timely in accordance with NCQA standards.

Other Duties:

·        Prepare for onsite audits by the Delegated Plans when applicable.

·        Oversee all job functions that support maintenance of NCQA or other    certifications.

·        Oversees maintenance of accurate information of provider office information for provider directories.

·        Perform special projects as assigned.

·        Perform other duties as assigned.