Medical Staff Credentialing Supervisor jobs in Pittsburgh, PA

UPMC Community Care Behavioral Health is seeking a full-time Supervisor, Credentialing to support the Credentialing-Contracting team within the CCBH Network Department!

The Credentialing Supervisor will work daylight hours, Monday through Friday, in a remote capacity! Individuals residing in the Allegheny County area and/or Western Pennsylvania are preferred, as there may be an occasional in-person event at the local CCBH office in Downtown Pittsburgh.

The Credentialing Supervisor handles day-to-day operations of the credentialing functions, monitoring compliance with all regulatory requirements, policies, and procedures in conjunction with the staff. This role also prepares agendas for the Credentialing Committee, communicates with the committee Chair(s), and supports business needs related to the department's volume of providers.

The Credentialing Supervisor is responsible for ensuring the accuracy and integrity of the Credentialing processes in compliance with quality policies and procedures (e.g. NCQA), monitoring and tracking trends to limit errors. The ideal candidate for this position will have exceptional attention to detail, data entry skills, and computer skills, as well as a strong background in credentialing. While previous supervisory experience is preferred, varying levels and backgrounds of leadership experience will be considered!

Responsibilities:

• Demonstrate knowledge of state, federal, and NCQA regulations concerning credentialing and re-credentialing.
• Recruit and train credentialing staff, conducting performance reviews as required by policy. 
• Prioritize work assignments to ensure timely completion with satisfactory results, utilizing and facilitating attention to the Provider-At-Risk list.
• Review practitioner credentialing/re-credentialing and facility assessment/re-assessment files prior to presentation for completion of process.
• Prepare monthly, quarterly, and annual reports as needed concerning credentialing and re-credentialing.
• Work with ISD Department in developing report specifications.
• Communicate with Provider Relations and Quality Management concerning credentialing/re-credentialing work flow and related issues.
• Participate in developing performance standards and completing monitoring of the credentialing function.
• Supervise day-to-day tasks performed by Credentialing Analysts and Site Reviewers.
• Participate in training sessions for Credentialing staff, Community Care staff, and outside customers regarding credentialing and re-credentialing.
• Review monthly credentialing meeting minutes with meeting coordinator.
• Maintain a comprehensive binder/electronic file containing monthly Credentialing Committee minutes with attachments.
• Follow-up with Provider Relations and correspondence to Providers as result of the Credentialing Committee credentialing decisions.
• Maintain confidentiality and security standards throughout all departmental processes.
• Recruit network providers for Credentialing Committee membership.
• Organize periodic updates of facility data relative to physicians with privileges to prescribe medication as part of an OMHSAS report requirement. 
• Review all provider site visits and medical record reviews.
• Develop all provider site visit deficiency letters.
• Develop all provider medical record review deficiency letters and reschedule review within 6 months of credentialing decision or until corrective action is demonstrated.
• Monitor the performance and expenditures related to provider site visits and CCBH Site Reviewers.
• Establish an effective method to communicate changes in policy or forms to Site Reviewers. 
• Train Site Reviewers and needed documents to include CV, copy of license, and signed confidentiality statements.
• Facilitate monthly team meetings to discuss credentialing activity, action plans to address identified challenges, and resource management to ensure consistent departmental performance relative to all credentialing processes.
• Complete all special project data entry at 99% accuracy.
• Identify opportunities for improving processes that support task completion within NCQA Credentialing Standards and the expectations defined in Community Care Credentialing Policies and for maximum use of resources at Community Care.
• Notify supervisor of major problems or concerns within 24 hours concerning provider data.
• Develop working relationship with Provider Relations, Quality Management, and other Departments at Community Care.
• Maintain and update credentialing and re-credentialing policy and procedure, reviewing at least quarterly with the Project Coordinator.
• Prepare for state and NCQA site visits. 
• Prepare and organize data, reports, and follow-up as indicated within Quality Management work plan.
• Maintain positive, professional attitude with Providers and internal customers 100% of the time.