[Hiring] Supervisor Credentialing and Privileging Office @Highmark Health

Role Description

This job coordinates, supervises and implements day to day operations within the AHN Credentialing & Privileging Office to include appointment, reappointment and ongoing verification activities of the Medical Staff and Allied Health Professional Staff. Assists management in overseeing investigation and documentation of practitioner credentials and privileges, and in utilizing specialized knowledge to obtain verification of all aspects of a practitioner's background, training and past practice.

Essential Responsibilities

• Supervises daily activities of the teams.
• Reviews management reports to monitor workflow to ensure that providers are meeting credentialing deadlines while following regulatory standards.
• Audits providers records for accuracy of verifications, DOP, staff categories and dates after board approval.
• Participates and assists in DOH & TJC audits. (30%)
• Initiates monthly team check-ins to discuss performance and goals.
• Evaluates and oversees goal performance and implements improvement plans when needed.
• Travels to each facility to ensure departmental processes are being followed and provide guidance to staff. (20%)
• Collaborates with staff during weekly team calls keeping providers on track for targeted privileging dates.
• Evaluates pipeline reports identifying any providers that have a delay in the process, and assists in finding solutions for any concerns or related issues. (20%)
• Reviews and audits applications for inclusion into weekly committee agenda verifying that all providers and documents are included and approval signatures were obtained. (20%)
• Onboarding and training of new staff which includes but is not limited to identifying, interviewing and selecting qualified candidates.
• Maintains work hours, PTO and schedules.
• Approves time cards through Kronos. (10%)
• Other related duties as required.

Qualifications

• Minimum: 3 years with physician credentialing and privileging, medical education, hospital environment, health insurance or managed care.
• 1 year of coordinating, coaching and supervising or leading the work of others.
• Proficiency in PC applications including Microsoft Office.
• Preferred: Bachelor's Degree.
• Customer Service Experience.
• Certified Provider Credentialing Specialist (CPCS) OR Certified Professional Medical Services Management (CPMSM).

Requirements

• This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.
• Employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times.
• Compliance with the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures.
• Compliance with all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy.
• Adherence to applicable federal and state laws, rules, and regulations as well as company policies and training.

Benefits

• Pay Range Minimum: $27.36
• Pay Range Maximum: $44.13
• Base pay is determined by a variety of factors including a candidate’s qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations.
• The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets.