AmeriHealth Caritas Credentialing Supervisor in Philadelphia, Pennsylvania

Credentialing Supervisor

Location: Philadelphia, PA

Telecommuter?: No

ID**: 14144

Your career starts now. We’re looking for the next generation of health care leaders.

At AmeriHealth Caritas, we’re passionate about helping people get care, stay well and build healthy communities. As one of the nation's leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we’d like to hear from you.

Headquartered in Philadelphia, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services. Discover more about us atwww.amerihealthcaritas.com.

Your career starts now. We’re looking for the next generation of health care leaders.

At AmeriHealth Caritas, we’re passionate about helping people get care, stay well and build healthy communities. As one of the nation's leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we’d like to hear from you.

Headquartered in Philadelphia, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services. Discover more about us at www.amerihealthcaritas.com.

Responsibilities:

The Supervisor, Credentialing is responsible for the day-to-day operations and supervision of the credentialing staff. Maintains the Plan’s compliance with all state regulations and NCQA standards related to credentialing and recredentialing, including all interdepartmental and intradepartmental coordination, communication, education, and committee structure and support.

Credentialing/recredentialing functions include:

  • File maintenance and set-up.

  • Primary Source Verification.

  • Verbal, electronic and written communication with practitioners and their staff..

  • Preparation of routine and non-routine files for Credentialing Committee.

  • Data entry into the Application/Credentialing database.

  • Securing performance data.

  • Maintaining historical credentialing records.

Works in collaboration with the Contracting Department for timely and complete processing from application receipt through effective date for Plan participation. Maintain systems to support Credentialing committee structure. Participates on interdisciplinary committees to maintain understanding and participation in projects and policies related to compliance with credentialing standards. Participates in the annual HEDIS process in conjunction with the Quality Improvement staff. Participates in oversight activities conducted by the EQRO related to credentialing functions. Coordinates communication and direct data entry for the Plan's delegated practitioners.

Job-Related Requirements: Knowledge/Skills/Abilities

  • Required Bachelor's Degree or equivalent work history.

  • Required 3 to 5 yrs. managed care exp.

  • Required 2 to 4 yrs. credentialing exp. (Physician, Dental, Behavioral Health, Facility) within managed care

  • Required 2+ yrs. demonstrated supervisor, management, or team leadership skills

  • Required Credentialing Committee experience

  • Proficient in MS Office; working knowledge of FACETS and CACTUS

Candidates with solid Network Provider background in a managed care setting with be given strong consideration.

EOE Minorities/Females/Protected Veterans/Disabled