Supervisor, Credentialing – Health Partners – Corporate Service Center

Trinity Health Corporation Columbus, OH
Department:

OH1AC_60000_000 Administration

Expected Weekly Hours:

40

Shift:

Day Shift

Position Purpose:

At Mount Carmel, we're committed to making a meaningful difference in the lives of our patients and communities. Our colleagues – people like you – share our passion for always going above and beyond to provide the highest standards of care

Job Description Details:

Our colleagues are proud to go the extra mile. This dedication to doing what's right – and working together to make it all happen for our patients – is what truly sets Mount Carmel apart. Our Clinical Support teams ensure that success every day, and Mount Carmel ensures they have the resources and opportunities to succeed.

Our Credentialing Supervisor oversees credentialing staff, develops and monitors the processes and procedures that support Mount Carmel Health Partners clinically integrated network's (CIN) credentialing, re-credentialing, delegated payer credentialing contracts, provider contract terminations. Supervisor maintains positive/informative relationships with the entire CIN and payers with delegated credentialing contracts. The Supervisor is responsible for the appropriate documentation, integrity and timeliness of reporting utilizing the Provider credentialing database. The supervisor works closely with the Health Partners Executive team including the Director of Contract Administration Manager to maintain delegated managed care agreements and assist network practitioners in the credentialing process. Position has a high degree of interactions with physicians, the Central Verification Office and those payers who have delegated credentialing contracts. The high volume of work requires considerable organizational and project management. Ensure compliance with mandated regulatory agencies (i.e., NCQA, URAC, ODJFS, OSMB, OSNB, payer elements for claims processing) and ODI rules as it relates to physician/nursing participation in third-party payer plans.

Responsibilities

* Acts as the primary credentialing lead between Health Partners, Mount Carmel Central Verification Office (CVO), Central Billing and third-party payers.

* Directs, analyze all credentialing application processes and assures compliance of Health Partners credentialing policies, NCQA guidelines and payer requirements.

* Accountable for network credentialing provider database including updates and changes required for data integrity purposes.

* Responsible to ensure the Credentialing Program and all policies and procedures are current and compliant with regulatory requirements (NCQA) Ohio Revised Code (ORC); Federal Regulations; Healthcare Law.

* Review and analyze monthly reports obtained from State and Federal Authorities for monthly compliance monitoring and follow-up, as appropriate; documents all monthly ongoing monitoring to meet payer audits.

* Provides timely documented oversight of all credentialing delegation activities to meet NCQA and payor requirements for required compliance reporting, payer rosters and annual audits.

* Prepares credentialing Board Report, Board Status and Board Resolution for review by the Board of Directors.

* Oversees the collection and analysis of all required credentialing elements required for credentialing and prepares monthly practitioner reports for the Credentialing Committee and decision making;

* Prepares monthly processing of payment processing for credentialing fees.

* Prepares and composes confidential letters for physicians for credentialing, disciplinary actions, etc. as appropriate for Credentialing Committee Chairman.

Requirements/Qualifications

* Education: Bachelor's degree required or equivalent combination of education and experience.

* Licensure / Certification: Certification: Certified Professional Credentialing Services (CPSC) preferred.

* Experience: At least 5 or more years progressively challenging provider credentialing experience required.

* Working knowledge of regulatory credentialing requirements for the National Committee for Quality Assurance (NCQA), Credentialing Standards (CMS); Ohio Department of Insurance (ODI) Regulations; Code of Federal Regulations (ORC); Healthcare Law.

* Working knowledge of personal computers, MC Office Suite, and experience with database management software.

Discovering opportunities, support and excellence – all while making a real difference in patients' lives – begins at Mount Carmel. Find a new beginning and advance your career with us.

Mount Carmel and all its affiliates are proud to be equal opportunity employers. We do not discriminate on the basis of race, gender, religion, or physical ability.

Trinity Health's Commitment to Diversity and Inclusion

Trinity Health employs more than 120,000 colleagues at dozens of hospitals and hundreds of health centers in 21 states. Because we serve diverse populations, our colleagues are trained to recognize the cultural beliefs, values, traditions, language preferences, and health practices of the communities that we serve and to apply that knowledge to produce positive health outcomes. We also recognize that each of us has a different way of thinking and perceiving our world and that these differences often lead to innovative solutions.

Trinity Health's dedication to diversity includes a unified workforce (through training and education, recruitment, retention and development), commitment and accountability, communication, community partnerships, and supplier diversity.