Description
At HCSC, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers.
Join HCSC and be part of a purpose-driven company that will invest in your professional development.
This position is responsible for managing the enterprise credentialing committee activities in compliance with accreditation standards and state regulations and managing the ongoing monitoring process and administrative denial processes. This position manages the onboarding/recredentialing providers presented to committee, decisions sent to the providers according to the required turnaround time and the network terminations managed accurately. Collaborate with the interdepartmental leaders for the development, implementation and maintenance of policies, procedures, workflow processes and developing departmental goals related to Credentialing committee actives. This position managing the team of credentialing coordinators and Sr credentialing representatives and ensures the teams meet or exceed goals, initiatives and operational effectiveness.Required Job Qualifications:
- Bachelor Degree OR 4 years business experience.
- Plus 4 years' experience in credentialing OR 4 years supervisory experience in a production or inventory driven environment
- 3 years' management or leadership experience.
- Experience in a production or inventory driven environment with a focus on operations, state and federal regulations, industry standards and/or quality concepts.
- Experience implementing and managing projects and programs.
- Experience implementing policies, procedures, processes, and workflows.
- Analytical skills and experience identifying and resolving workflow and system problems.
- Written, verbal and interpersonal communication skills to present clear, concise and accurate information; facilitate meetings and manage diverse groups, and build relationships with employees and external customers.
Preferred Job Qualifications:
- Knowledge of Symplr Payer, PPW.
- Knowledge of NCQA, URAC, CMS, and state Departments of Insurance regulatory requirements.
- Experience in managed care credentialing, Medical Practice or Medical Staff office.
- Experience developing innovative solutions to ensure objectives are accomplished.
- Knowledge of Vistar/Vistar.
This is a Flex (Hybrid) role: 3 days in office; 2 days remote.
Sponsorship is not available.
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Compensation: $60,300.00 - $133,400.00
Exact compensation may vary based on skills, experience, and location
HCSC Employment Statement:
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.
To learn more about available benefits, please click https://careers.hcsc.com/totalrewards
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