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Supervisor - Credentialing - 996619
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Job Number: 506006
Work Type: Full Time with Full Benefits
Location: Fort Lauderdale-Davie, Florida
Department: DCO Contracting & Credentialing
Categories: Healthcare - Clinic Administration, Medical Professionals & Technicians
| About Us: |
We are excited that you are considering joining Nova Southeastern University!
We appreciate your support in making NSU the preeminent place to live, work, study and grow. Thank you for your interest in a career with Nova Southeastern University. NSU considers applicants for all positions without regard to race, color, religion, creed, age, sex, sexual orientation, gender identity or expression, genetic information, disability, political affiliation or belief, national origin, marital or veteran status or any other legally protected status. |
| Job Title: | Supervisor - Credentialing - 996619 |
| Location: | Fort Lauderdale-Davie, Florida |
| Work Type: | Full Time with Full Benefits |
| Job Category: | Exempt |
| Hiring Range: | |
| Pay Basis: |
Annually |
| Subject to Grant Funding?: | No |
| Essential Job Functions: | 1. Plans, directs, supervises, and coordinates work activities of subordinates and staff, including hiring, coaching, evaluating, and terminating, all in accordance with university policies and procedures. 2. Conducts thorough background investigation and research of application files; completes provider credentialing and re-credentialing applications; monitors applications and follows-up; and processes applications with respective agency and/or third-party payer to ensure compliance. 3. Performs credentialing of faculty and professional staff with Medicare, Medicaid, HMO, PPOs, and other 3rd party carriers to ensure providers are contracted. 4. Maintains up-to-day data for each provider in databases and online systems as it relates to education, training, licensing, and experience to ensure practice addresses are current with health plans, agencies, and other entities. 5. Applies for Provider's Hospital Privileges; is responsible for hospital reappointments; also responsible for Medical Staff Due payments requests and payment processing to ensure timely and accurate treatment. 6. Drives and implements seamless protocols for gathering credentialing data from health care providers. 7. Assists in the development and implementation of process improvement initiatives. 8. Participates in the development of policies and procedures. 9. Tracks license and certification expirations for providers to ensure timely renewal; ensures contracts and licenses do not expire and submits new licensing information to appropriate entities. 10. Maintains provider credential files securely and provides support for college review committees. 11. Keeps up to date on new policies and procedures from third-party payers and communicates with staff. 12. Ensures interpretation and compliance with the appropriate accrediting and regulatory agencies. 13. Assists with managed care delegated credentialing audits; conducts internal file audits, and audits health plan directories. 14. Responds to inquiries from other healthcare organizations and interphases with internal and external customers on day-to-day credentialing and privilege issues. 15. Participates in contracting functions and is responsible for understanding contract terms. 16. Completes other projects as assigned. 17. Performs other duties as assigned. |
| Marginal Job Functions: | |
| Required Knowledge, Skills, & Abilities: | Knowledge: 1. Thorough knowledge of the credentialing process. 2. Thorough knowledge of related accreditation and certification requirements. 3. Personnel and Human Resources – Working knowledge of principles and procedures for personnel recruitment, selection, training, and supervision. 4. English Language - Working knowledge of the structure and content of the English language including the meaning and spelling of words, rules of composition, and grammar. 5. Advanced knowledge of MS Office Suite (Outlook, Word, Excel, PowerPoint). Skills: 1. Speaking - Proficient skills in talking to others to convey information effectively. 2. Reading Comprehension - Proficient understanding of written sentences and paragraphs in work-related documents. 3. Writing - Proficient skills in communicating effectively in writing as appropriate for the needs of the audience. 4. Complex Problem Solving - Proficient skills in identifying complex problems and reviewing related information to develop and evaluate options and implement solutions. 5. Time Management - Proficient skills in managing one's own time and the time of others. 6. Judgment and Decision Making - Proficient skills in considering the relative costs and benefits of potential actions to choose the appropriate one. 7. Supervisory skills – Proficient supervisory, training and leadership skills, manage and motivate a large team. 8. Excellent attention to detail and high degree of accuracy. Abilities: 1. Problem Sensitivity - The ability to tell when something is wrong or is likely to go wrong. It does not involve solving the problem, only recognizing there is a problem. 2. Inductive Reasoning - The ability to combine pieces of information to form general rules or conclusions (including finding a relationship among seemingly unrelated events). 3. Deductive Reasoning - The ability to apply general rules to specific problems to produce answers that make sense. 4. Ability to research and analyze data. 5. Ability to set priorities and manage time effectively. Physical Requirements and Working Environment: 1. Speech Recognition - Must be able to identify and understand the speech of another person. 2. Speech Clarity - Must be able to speak clearly so others can understand you. 3. Near Vision - Must be able to see details at close range (within a few feet of the observer). 4. Travel - Must be able to travel on a daily and/or overnight basis. 5. May be required to work nights or weekends. 6. May be exposed to short, intermittent, and/or prolonged periods of sitting and/or standing in the performance of job duties. 7. May be required to accomplish job duties using various types of equipment/supplies, to include but not limited to pens, pencils, and computer keyboards. |
| Job Requirements: | |
| Required Certifications/Licensures: | |
| Required Education: | Associate degree or sixty (60) completed college credits hours |
| Major (if required): | |
| Required Experience: | 1. Minimum five (5) years of credentialing and/or contracting experience. 2. Prior supervisory experience. |
| Preferred Qualifications: | 1. Experience with credentialing and/or insurance contracting in a medical setting. 2. Experience with credentialing software. 3. Certified Provider Credentialing Specialist (CPCS). |
| Is this a safety sensitive position? | No |
| Background Screening Required? | Yes |
| Pre-Employment Conditions: |
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| Sensitivity Disclaimer: | Nova Southeastern University is in full compliance with the Americans with Disabilities Act (ADA) and does not discriminate with regard to applicants or employees with disabilities, and will make reasonable accommodation when necessary. |
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