[Hiring] Senior Manager Provider Administration & Credentialing @Health Care Service Corporation

Role Description

This position is responsible for managing the credentialing process in compliance with agency regulations (Department of Insurance, CMS, DOD/TriCare, NCQA and URAC), managing the process of collection and maintenance of professional provider data, and managing credentialing audits.

• Responsible for the development, implementation and maintenance of policies, procedures, and workflow processes.
• Develop departmental goals, ensuring the department meets or exceeds goals and operational effectiveness.
• Develop performance standards, monitor and analyze unit production and quality statistics to ensure achievement of goals.
• Ensure personnel resources are appropriately allocated.
• Participate as a Lead in monthly Provider Network Committee and quarterly Institutional Provider Workgroup meetings.
• Work with Vice Presidents, Directors, and Managers from across the state and the Enterprise to address issues and improve processes.

Qualifications

• Bachelor’s Degree and 7 years’ experience in managed care provider contracting, network management, or credentialing OR 11 years’ experience in the same fields.
• Must have 3 years management experience.
• Management skills to cultivate a creative, supportive, and innovative environment.
• Coaching and training skills.
• Experience in a production environment with a focus on operations, state and federal regulations, industry standards, and quality concepts.
• Experience developing, implementing, and managing projects and programs.
• Experience developing and implementing policies, procedures, processes, and workflows.
• Knowledge of NCQA, URAC, CMS, and state Department of Insurance regulatory requirements.
• Analytical skills and experience identifying and resolving workflow and system problems.
• Written, verbal, and interpersonal communication skills.
• Ability to present clear, concise, and accurate information.
• Ability to facilitate diverse groups and build relationships with employees and external customers.

Requirements

• Proficiency in data tools (Excel, PowerBI, data mining, data reporting) - HIGH PREFERRED.
• Knowledge of HCSC provider systems.
• Experience developing innovative solutions to ensure objectives are accomplished.
• Sponsorship will not be provided for this role.
• This is a Telecommute (Remote) role.

Benefits

• Health and wellness benefits.
• 401(k) savings plan.
• Pension plan.
• Paid time off.
• Paid parental leave.
• Disability insurance.
• Supplemental life insurance.
• Employee assistance program.
• Paid holidays.
• Tuition reimbursement.
• Other incentives.

Company Description

We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued.

• All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics.
• We are a drug-free and smoke-free workplace.
• Employment may be contingent upon successful completion of drug screening in accordance with applicable law.