Credentialing Operations Team Lead / Supervisor

Credentialing Operations Team Lead / Supervisor

At Claritev, we pride ourselves on being a dynamic team of innovative professionals. Our purpose is simple - we strive to bend the cost curve in healthcare for all. Our dedication to service excellence extends to all our stakeholders - internal and external - driving us to consistently exceed expectations. We are intentionally bold, we foster innovation, we nurture accountability, we champion diversity, and empower each other to illuminate our collective potential.

Be part of our amazing transformational journey as we optimize the opportunity towards becoming a leading technology, data, and innovation voice in healthcare. Onward and Upward!!!

JOB SUMMARY

Provide leadership, direction and back up support to staff responsible for functional activities related to initial credentialing and recredentialing of the Claritev Provider Networks. .

DUTIES

1. Ensure all (re)credentialing processes are in compliance with NCQA accreditation standards in an effort to maintain accreditation by effectively and efficiently managing department activities.
   2. Credentialing
   * Oversee operational processes cycle in support of staff, time and quality objectives for (re)credentialing to meet NCQA requirements and additionally in support of all Claritev, Beech and HEOS networks.
   * Manage recredentialing of non-respondent inventories.
   3. Policy Management --Assure compliance of staff for all applicable policies and procedures and contribute regularly to maintaining all updates to all policies impacting the Credentialing Operations business unit(s).
   4. Reporting & Data Integrity -- Produce reporting for staff productivity auditing for data integrity and coordinating results with management for departmental reporting.
   5. Training --Identify training needs for staff surrounding the credentialing and recredentialing process as well as the delivery of NCQA related training.
   6. Project Management --Collaborate on projects according to the needs of the department and in support of corporate objectives acting as a subject matter expert (SME) for (re)credentialing operation information, processes and procedures.
   7. Technical Skill -- Experience in using Microsoft suite of products including Excel and Access to manage large data sets and analyze complex business scenarios
   8. Select, develop, and evaluate staff to ensure the efficient operation of department.
   9. Collaborate and communicate across disciplines and departments.
   10. Ensure compliance with HIPAA regulations and requirements.
   11. Demonstrate commitment to the Company's core values.
   12. Responsible for routine internal monitoring and auditing of compliance risks, prompt response to compliance issues as they are raised, investigation of potential compliance problems as identified in the course of self-evaluation and audits, correction of such problems promptly and thoroughly to reduce the potential for recurrence as required by applicable state and federal laws, regulations and MPI's Compliance Programs
   13. The position responsibilities outlined above are in no way to be construed as all encompassing. Other duties, responsibilities, and qualifications may be required and/or assigned as necessary.

JOB SCOPE:
The incumbent works under limited supervision, leading and motivating a remote worker team that is primarily focused on credentialing and recredentialing of the Claritev Provider Networks. The incumbent must use independent judgment to identify issues, trends and possible problems and recommend action plans to address. The incumbent must be able to balance several projects at a time that may be varied or complex, while maintaining a focus on achieving all department goals for quality and service. This is a management position overseeing direct reports. Responsibilities may include some budgetary functions. 45 percent of overall responsibilities are dedicated to Quality Management (QM) functions which consist of collaborating with management to identify, develop and support quality and training improvements.

COMPENSATION

The salary range for this position is $55-70K. Specific offers take into account a candidate's education, experience and skills, as well as the candidate's work location and internal equity. This position is also eligible for health insurance, 401k and bonus opportunity.