Supervisor, Managed Care
Location
United States
Posted
1 day ago
Salary
$80.9K - $134.0K / year
Seniority
Mid Level
No structured requirement data.
Job Description
Supervisor, Managed Care
Cardinal Health
Role Description The position is responsible for managing the credentialing/enrollment team and ensuring an active status with all contracted payors for all groups and providers. The position is also responsible for ensuring licensure is updated and active for all groups, providers, and facilities. - Supervises day-to-day credentialing/enrollment operations, including assigning and balancing workloads across the team, reviewing work output for accuracy and completeness, and providing timely feedback and coaching to team members. - Responsible for documenting and tracking all credentialing, re-credentialing, provider enrollment, and hospital privileging activities within the credentialing software environment. - Assists new providers with obtaining required clinical licenses and coordinates the full cycle onboarding and enrollment into Medicaid, Medicare, and the commercial insurance plans. - Develops, documents, and maintains standard operating procedures (SOPs) for all credentialing and enrollment workflows, including provider onboarding. - Conducts regular quality audits of team members' credentialing and enrollment work, documenting findings, and implementing corrective actions. - Plans and delivers training for new and existing team members on credentialing/enrollment workflows, platform functionality, payer requirements, and departmental SOPs. - Serves as the first point of escalation for credentialing and enrollment issues that cannot be resolved at the coordinator level. - Maintain and monitor all licenses and certifications in the database to ensure compliance. Qualifications - At least five (5) years of experience of credentialing experience in a managed care or provider setting, including experience using a credentialing database preferred. - Demonstrated personnel leadership (remote and onsite), provider enrollment technical expertise, effective and professional communication, disciplined execution of strategic initiatives, and relationship management preferred. - Specific knowledge of the payer environment and payer issues, particularly billing and collections. - Strong knowledge of the rules/regulations of Medicare/Medicaid and other government payors, as well as commercial insurers and specialty contracts to ensure accurate and timely billing and payment of claims. - Ability to work a flexible schedule (including overtime, and weekends), as necessary. - Excellent customer service and communication skills. - Ability to work independently and as part of a team. - Working experience with Excel spreadsheets and Microsoft Word documents. Requirements - Coordinates and supervises the daily activities of operations or business staff. - Administers and exercises policies and procedures. - Ensures employees operate within guidelines. - Decisions have a direct impact to work unit operations and customers. - Frequently interacts with subordinates, customers, and peer groups at various management levels. - Interactions normally involve information exchange and basic problem resolution. Benefits - Medical, dental and vision coverage. - Paid time off plan. - Health savings account (HSA). - 401k savings plan. - Access to wages before pay day with myFlexPay. - Flexible spending accounts (FSAs). - Short- and long-term disability coverage. - Work-Life resources. - Paid parental leave. - Healthy lifestyle programs.
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