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Credentialing Supervisor
This position is: Full Time
Position Location: Lake Charles, LA

JOB TITLE:    Credentialing Supervisor

GENERAL SUMMARY OF DUTIES:  The Credentialing Supervisor maintains and transmits pertinent credentialing information for each of the practitioners at Imperial Health to ensure that partners and mid-level providers continuously meet the credentials, standards, and requirements of hospitals, entities and healthcare networks and coordinates these efforts with Credentialing Coordinator(s) within the credentialing department.

SUPERVISION REQUIRED:  Assistant Administrator

SUPERVISION EXERCISED: Credentialing Coordinator                                                           

ESSENTIAL FUNCTIONS:

 

  • Maintain a current credentials file on all practitioners and accurate, up-to-date information in an electronic database (e.g. CAQH), including malpractice summary.

 

  • Responsible for obtaining upgrades to the provider database as needed.

 

  • Facilitate and maintain credentialing and re-credentialing applications for the hospitals, health plans and other facilities, as appropriate, for all practitioners affiliated with Imperial Health.

 

  • Ensure that all practitioners meet the requirements at all times for participation in health plans, including Medicare and Medicaid enrollment and assists with requests for revalidation.

 

  • Track, record, and file current medical licensure, DEA, CDS, CME, certifications, and malpractice insurance for all practitioners and provide such to hospitals, health plans, and other facilities as appropriate.

 

  • Facilitate the renewal of medical licensure, DEA, and CDS.

 

  • Submit malpractice insurance applications for all practitioners and facilitate payment of appropriate coverage.

 

  • Notifies malpractice carrier of departing practitioners and requests refunds accordingly.

 

  • Transmit and disseminate confidential information regarding current practitioners, locum tenens, and those who have resigned from Imperial Health to hospitals, health plans, malpractice carrier, and other facilities as appropriate.

 

  • Credential physicians for locum tenens assignments within Imperial Health and/or Urgent Care Centers. Prepare a profile of the covering provider and send to appropriate departments for review.

 

  • Maintain up-to-date practitioner listing of payor network participation on Imperial Health’s intranet.

 

  • Prepare for and participate in annual audits by PPO Plus of credentials files and Credentialing Policies and Procedures. Provide documentation of review by Physician Reviewer and consideration and action taken by Compliance Committee for each physician.

 

  • Facilitate and maintain credentialing and re-credentialing applications of practitioners who have privileges at the Imperial Health Endoscopy Surgical Center.

 

  • Responsible for submitting re-credentialing applications for the Imperial Health Endoscopy Surgical Center to payor networks for continued participation.

 

  • Responsible for coordinating and covering scheduled and unscheduled absences of Credentialing Coordinator(s).

 

  • Responsible for monitoring timely submission/completion of overall credentialing tasks with deadlines and/or expiration dates (e.g. licenses, payor/facility affiliations etc.).

 

  • Other duties as assigned as assigned.

KNOWLEDGE, SKILLS & ABILITIES:

  • Must possess strong organizational and communication skills
  • Ability to professionally convey the urgency of time-sensitive requests
  • Able to meet deadlines
  • Work well under pressure
  • Ability to promote teamwork

 

Requirements:

EDUCATION REQUIREMENTS:  

Associates Degree in related field preferred. Minimum high school diploma or equivalent with experience as listed below.

EXPERIENCE:

  • Minimum of three (3) years of Business Office/Administrative experience in a medical office/facility setting or
  • Minimum of two (2) years in supervisory role in a medical office/facility setting.

 

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