Supervisor, Credentialing

UPMC Community Care Behavioral Health is seeking a full-time Supervisor, Credentialing to support the Credentialing-Contracting team within the CCBH Network Department!The Credentialing Supervisor will work daylight hours, Monday through Friday, in a remote capacity! Individuals residing in the Allegheny County area and/or Western Pennsylvania are preferred, as there may be an occasional in-person event at the local CCBH office in Downtown Pittsburgh.The Credentialing Supervisor handles day-to-day operations of the credentialing functions, monitoring compliance with all regulatory requirements, policies, and procedures in conjunction with the staff. This role also prepares agendas for the Credentialing Committee, communicates with the committee Chair(s), and supports business needs related to the department's volume of providers.The Credentialing Supervisor is responsible for ensuring the accuracy and integrity of the Credentialing processes in compliance with quality policies and procedures (e.g. NCQA), monitoring and tracking trends to limit errors. The ideal candidate for this position will have exceptional attention to detail, data entry skills, and computer skills, as well as a strong background in credentialing. While previous supervisory experience is preferred, varying levels and backgrounds of leadership experience will be considered!Responsibilities:

Participate in training sessions for Credentialing staff, Community Care staff, and outside customers regarding credentialing and re-credentialing.

Establish an effective method to communicate changes in policy or forms to Site Reviewers.

Demonstrate knowledge of state, federal, and NCQA regulations concerning credentialing and re-credentialing.

Develop all provider medical record review deficiency letters and reschedule review within 6 months of credentialing decision or until corrective action is demonstrated.

Train Site Reviewers and needed documents to include CV, copy of license, and signed confidentiality statements.

Prepare monthly, quarterly, and annual reports as needed concerning credentialing and re-credentialing.

Communicate with Provider Relations and Quality Management concerning credentialing/re-credentialing workflow and related issues.

Review all provider site visits and medical record reviews.

Organize periodic updates of facility data relative to physicians with privileges to prescribe medication as part of an OMHSAS report requirement.

Maintain positive, professional attitude with Providers and internal customers 100% of the time.

Recruit and train credentialing staff, conducting performance reviews as required by policy.

Review practitioner credentialing/re-credentialing and facility assessment/re-assessment files prior to presentation for completion of process.

Facilitate monthly team meetings to discuss credentialing activity, action plans to address identified challenges, and resource management to ensure consistent departmental performance relative to all credentialing processes.

Identify opportunities for improving processes that support task completion within NCQA Credentialing Standards and the expectations defined in Community Care Credentialing Policies and for maximum use of resources at Community Care.

Review monthly credentialing meeting minutes with meeting coordinator.

Monitor the performance and expenditures related to provider site visits and CCBH Site Reviewers.

Develop working relationships with Provider Relations, Quality Management, and other Departments at Community Care.

Recruit network providers for Credentialing Committee membership.

Supervise day-to-day tasks performed by Credentialing Analysts and Site Reviewers.

Maintain a comprehensive binder containing monthly Credentialing Committee minutes with attachments.

Maintain and update credentialing and re-credentialing policy and procedure, reviewing at least quarterly with the Project Coordinator.

Prepare for state and NCQA site visits.

Follow-up with Provider Relations and correspondence to Providers as result of the Credentialing Committee credentialing decisions.

Participate in developing performance standards and completing monitoring of the credentialing function.

Develop all provider site visit deficiency letters.

Work with IS Department in developing report specifications.

Maintain confidentiality and security standards throughout all departmental processes.

Complete all special project data entry at 99% accuracy.

Notify supervisor of major problems or concerns within 24 hours concerning provider data.

Prepare and organize data, reports, and follow-up as indicated within Quality Management work plan.

Prioritize work assignments to ensure timely completion with satisfactory results, utilizing and facilitating attention to the Provider-At-Risk list.

High School diploma or equivalent required.

Some college with business concentration required.

Evidence of continuing education in business, computer, or managed care/credentialing areas.

6 years of experience with credentialing and re-credentialing in a hospital or managed care setting.

Ability to work well independently and handle multiple priorities to meet deadlines.

Excellent written/verbal skills.

Ability to take and transcribe minutes.

Ability to gather and manipulate data.

Strong organizational skills.

Ability to type 70-80 WPM.

Working knowledge of various computer programs including Word processing, charts and graphs, and databases with demonstrated competence in applications.

Licensure, Certifications, and Clearances:

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UPMC is an Equal Opportunity Employer/Disability/Veteran