• Credentialing Supervisor

    Job Locations US-NC-Hickory
    Posted Date 1 week ago(12/6/2018 8:30 AM)
    Job ID
    # of Openings
    Community and Social Services
  • Overview

    Excellent Benefits Package!!!

    Projected Hiring Range: $51,395 – $54,100


    Closing Date:  12/20/2018 by 4 PM


    Primary Purpose of Position: This position assists in the credentialing, development and management of the provider network for consumers who have been identified as having mental health, substance abuse or intellectual development disability needs.




    Role and Responsibilities:

    A Provider Network Credentialing Supervisor’s primary duties may be one or more of the following:

    • Provides direct supervision to credentialing staff including, recruiting, hiring, training and providing disciplinary action to individuals as needed;
    • Ensures compliance with all credentialing regulations and requirements including primary source verification, storage or records, credentialing staff training and hospital delegation agreements;
    • Oversees credentialing and enrollment of providers into the Partners Network according to parameters determined for qualifications and needs of the Network;
    • Assists in the acquisition and implementation of a credentialing database;
    • Obtains and maintains time sensitive confidential provider information;
    • Oversees the completion of routine and ongoing contract compliance monitoring to ensure that services are consistent with funding requirements, best practices, provider contracts and federal/state rules and regulations;
    • Interprets audit results, identifies trends/patterns that impact service/system quality, and then implements interventions aimed at addressing these trends/patterns with the outcome of services delivery to consumers at the highest degree of quality;
    • Serves as a resource to other departments within the LME/MCO on credentialing related issues;
    • Serves as a liaison with other departments within the LME/MCO and with various NC DHHS Departments, per rule requirements, to coordinate Specialist’s activities and findings;
    • Participates in Provider Forums as requested and provides technical support and assistance to Provider Councils as needed;
    • Participates in oversight and monitoring reviews of the MCO including but not limited to URAC, Mercer and EQR reviews as appropriate;
    • Develops and maintains policies and procedures related to credentialing.


    Knowledge, Skills and Abilities:

    • Considerable knowledge of the laws, regulations and policies that govern the program
    • Exceptional interpersonal and communication skills
    • Strong problem solving, negotiation, arbitration, and conflict resolution skills
    • Excellent computer skills and proficiency in Microsoft Office products (such as Word, Excel, Outlook, and PowerPoint
    • Demonstrated ability to verify documents for accuracy and completeness; to understand and apply laws, rules and regulations to various situations; to apply regulations and policies for maintenance of consumer medical records, personnel records, and facility licensure requirements
    • Ability to make prompt independent decisions based upon relevant facts
    • Ability to establish rapport and maintain effective working relationships
    • Ability to act with tact and diplomacy in all situations
    • Ability to maintain strict confidentiality in all areas of work



    Education/Experience Required: Bachelor’s Degree and three (3) years of credentialing, auditing or monitoring experience in MH/SU/IDD, including two (2) years Administrative Supervisory experience. Must have ability to travel.


    Education/Experience Preferred: Master’s Degree with clinical licensure preferred. Certified Provider Credentialing Specialist (CPCS) and/or Registered Healthcare Information Technician (RHIT) preferred.



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