The supervisor has various duties and responsibilities working within a high volume, goal-driven environment (estimated target: 75 to 100 files per week across a team), contributes to the overall productivity of the Centralized Processing team by directly supervising 3 - 6 staff members responsible for using medical staff credentialing and provider payer enrollment techniques, workflows, and best practices. Implements credentialing and health plan payer enrollment function processes and monitors assigned staff compliance.
Auditing files for completion, monitoring results, and gaining/sustaining stakeholder buy-in. Initiates and cultivates partnerships with other members of the Centralized Processing team, department management, medical staff /hospital/health plan/payor leadership and information technology teams to ensure compliance and optimal efficiency for appropriate membership for UCSF Medical Staff, Advanced Practice Professionals and CVO contracted facilities (LPPH&C, School of Dentistry and others, as applicable), and important responder to data integrity/system interface issues, primary source credentialing information, onboarding and revenue channel disruptions as well as performs auditing functions pursuant to facility Bylaws, Rules and Regulations; Credentialing Policy and Procedures; and other applicable accreditation/payor standards (e.g.
NCQA, TJC, DHS, DMHC, CMS, delegated credentialing agreements, etc.). This role includes responsibilities and involvement in the department’s engagement, educational, and professional development activities (i.e. Staff Engagement Committee, Education & Development Committee, Diversity, Equity, and Inclusion Committee, etc.) to achieve department and organization goals/work plans.
Facilitator of team meetings, preparation of agendas and related materials for team huddles, medical staff meetings, and peer review activities. Monitors compliance with medical staff bylaws, provider enrollment requirements, rules, regulations, policies, and procedures. Interprets and develops policy and procedures, and manages training and orientations to a variety of constituents to sustain best practices.
Responsibilities The supervisor has various duties and responsibilities working within a high volume, goal-driven environment (estimated target: 75 to 100 files per week across a team), contributes to the overall productivity of the Centralized Processing team by directly supervising 3 - 6 staff members responsible for using medical staff credentialing and provider payer enrollment techniques, workflows, and best practices.
Implements credentialing and health plan payer enrollment function processes and monitors assigned staff compliance. Auditing files for completion, monitoring results, and gaining/sustaining stakeholder buy-in. Initiates and cultivates partnerships with other members of the Centralized Processing team, department management, medical staff /hospital/health plan/payor leadership and information technology teams to ensure compliance and optimal efficiency for appropriate membership for UCSF Medical Staff, Advanced Practice Professionals and CVO contracted facilities (LPPH&C, School of Dentistry and others, as applicable), and important responder to data integrity/system interface issues, primary source credentialing information, onboarding and revenue channel disruptions as well as performs auditing functions pursuant to facility Bylaws, Rules and Regulations; Credentialing Policy and Procedures; and other applicable accreditation/payor standards (e.g.
NCQA, TJC, DHS, DMHC, CMS, delegated credentialing agreements, etc.). This role includes responsibilities and involvement in the department’s engagement, educational, and professional development activities (i.e. Staff Engagement Committee, Education & Development Committee, Diversity, Equity, and Inclusion Committee, etc.) to achieve department and organization goals/work plans.
Facilitator of team meetings, preparation of agendas and related materials for team huddles, medical staff meetings, and peer review activities. Monitors compliance with medical staff bylaws, provider enrollment requirements, rules, regulations, policies, and procedures. Interprets and develops policy and procedures, and manages training and orientations to a variety of constituents to sustain best practices.
Bachelor's degree in a related area or four years of relevant experience. Five years in a healthcare environment with emphasis in medical staff operations, academic medical centers and/or provider enrollment for third party payors and health plans. Three or more years working as a lead/supervisor or manager role.
Expert knowledge of TJC, NCQA, CMS, DHS, DMHC, ACGME and other applicable accreditation/regulatory requirements Demonstrated leadership skills. Motivates and inspires staff to improve the workflows and operations of the organization. Solid customer service skills.
Demonstrated ability to effectively manage multiple priorities. Maintains a broad range of external regulatory best practices and accounting and administrative operations. Proven ability to apply knowledge to recommend improvements.
Actively cooperates and supports the work of others. Effective communicator with peers, clinical staff, regulatory agencies, and multidisciplinary team members. Advanced critical and analytical thinking regarding complex and long-term projects.
Ability to recognize impediments, creatively address new problems, develop alternative plans, and formulate solutions. Advanced organizational and project management skills, including the ability to anticipate and plan for complex situations, define objectives, and adjust plans. Ability to see multiple assignments through, from inception to completion on schedule.
Ability to maintain a professional demeanor while working under pressure of constantly changing deadlines and priorities; possesses poise, diplomacy, discretion, initiative, resourcefulness, and a service orientation. Skills to interact with a diverse population of internal staff, physicians and administrators, external agencies, and physicians' offices. Demonstrated advanced computer skills using Microsoft Office Suite (Word, Excel, PowerPoint) and medical credentialing database application.
Advanced knowledge of data analysis, research and reporting, particularly regarding licensure compliance. The ability to obtain one of the following within the first 18 months of employment: Certified Provider Credentialing Specialist (CPCS), Certified Professional Medical Services Management (CPMSM), Certificated Professional in Healthcare Quality (CPHQ) or Certified Professional Coder. The ability to work onsite in our San Francisco office at least three days a week or more as required.
Full time · Day shift