What are the responsibilities and job description for the Credentialing Supervisor position at Austin Regional Clinic?
ABOUT AUSTIN REGIONAL CLINIC:
We have been voted a top Central Texas employer by our employees for 14 years! We have 27 locations and are one of central Texas’ largest professional medical groups. We offer the following benefits to eligible team members: Medical, Dental, Vision, Flexible Spending Accounts, Time Off, 401(k), EAP, Life Insurance, Long Term Disability, Tuition Reimbursement, Child Care Assistance, Health & Fitness, Sick Child Care Assistance and Development. For more information visit https://www.austinregionalclinic.com/careers/
PURPOSE
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.
ESSENTIAL FUNCTIONS
- 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.
QUALIFICATIONS
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.
Certificate/License
Certified Professional Credentialing Specialist (CPCS) preferred.
