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Corporate Functions & Operations WellCare - Credentialing Careers

Credentialing - Supervisor Job

Full Job Title: Supervisor, Credentialing - Houston, Texas

Job Number: 1705488

Location: Houston, TX

Date Posted: 11-20-2017

Provider, Facility, Ancillary credentialing, to include all aspects of the new applicant credentialing, re-credentialing; ongoing maintenance of provider credentials; report preparation, online verifications; serve as a trainer for credentialing associates; address escalated, complex cases.

Essential Functions:
  • Daily management of associates and processes which includes but not limited to: payroll, development and performance management. Provides significant input into associates' performance evaluations and hiring/termination situations.
  • Review applications and supporting documents in a virtual environment and apply policy and criteria required for credentialing processing.
  • Oversight of assigned CVO vendor processing.
  • Prepare files and materials for internal and external regulatory audits.
  • Maintain and update credentialing database and core system records.
  • Oversight of re-credentialing mailing, voluntary relinquishment and reinstatement processes.
  • Review issue cases prepared for Medical Director and Credentialing Committee review.
  • Attend and provide support for all assigned Credentialing Committee meetings.
  • General project management in support of department operations.
  • Liaison with assigned Configuration and Market personnel.
  • Create and maintain reports.
  • Provide training and support to credentialing associates and assist with handling complex questions and case reviews.
  • Demonstrate knowledge of credentialing regulatory and accreditation requirements (NCQA, CMS, Medicaid, etc.).
  • Perform other duties as assigned.
Additional Responsibilities:Candidate Education:
  • Required A High School or GED
Candidate Experience:
  • Required 4 years of experience in credentialing in a hospital or managed care setting
  • Required 1 year of experience in leading others
Candidate Skills:
  • Intermediate Demonstrated written communication skills
  • Intermediate Demonstrated interpersonal/verbal communication skills
  • Intermediate Ability to work as part of a team
  • Intermediate Ability to effectively present information and respond to questions from peers and management
  • Intermediate Other Ability to explain complex credentialing standards and processes to team members.
  • Intermediate Other Knowledge of credentialing software sufficient to develop appropriate reports on all aspects of credentialing
Licenses and Certifications:
A license in one of the following is required:
  • Preferred Other Certified Provider Credentialing specialist
Technical Skills:
  • Required Intermediate Microsoft Word
  • Required Intermediate Microsoft Excel
  • Required Intermediate Microsoft Outlook
  • Required Intermediate Other Ability to learn various software packages as necessary to perform job functions.

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Last Updated On: 12/9/2015