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Team Leader, Credentialing

Maumee, Ohio; Evansville, Indiana
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Description

At Paramount, we offer insurance to both large and small groups and also cater to Medicare (Paramount Elite) subscribers in northwest Ohio and southeast Michigan. Our Medicaid product (Paramount Advantage) services those living in the state of Ohio. We maintain an accreditation by the NCQA – the National Committee for Quality Assurance – for our Ohio HMO, Elite and Advantage products. We’re also part of ProMedica, which is ranked the second most integrated health system in the U.S. and No. 1 in the Midwest. For more information about Paramount, please visit our website http://www.paramounthealthcare.com.

 

Position Summary

A working Team leader responsible for supervising staff and day-to-day operations of the credentialing function.  Coordinate physician application process and credentials verification for the recredentialing process for all participating physicians and providers.  Ensure that the credentialing and recredentialing processes support the Health Plan's quality standards and legal responsibilities for all lines of business.

 

Accountabilities

1.    Supervise credentialing staff, ensuring that all Health Plan personnel policies are consistently administered through KPIs and systematic quarterly feedback and annual performance appraisals along with documented counseling/disciplinary procedures when necessary.
2.    Maintains an expert level knowledge of the credentialing and recredentialing process as evidenced by maintaining CPCS Certification.  Oversees all aspects of regulatory reviews to include ensuring that all policies and procedures are in compliance with all regulatory requirements.  Regulatory agencies, including, but not limited to, NCQA, ODM, CMS, ODI, ODH and any other State regulatory agency for which Health Plan participates.  
3.    Oversee all aspects of the credentialing and recredentialing processes ensuring that an audit trail of elements outlined in the Health Plan’s credentialing and recredentialing Policies and Procedures are maintained.  
4.    Provide Administrative support to the PAC to include attending all meetings and provide staff support by accurately taking of meeting minutes and track and assure timely follow-up on action issues at the request of the Council.
5.    Maintain an administrative role as it pertains to software applications.  This includes providing oversight of the Cactus credentialing database to include setting up necessary securities and configuration as requested as they pertain to the credentialing and recredentialing processes.
6.    Represents department in required meetings as it relates to credentialing.
7.    Ensure integrity, to include accurate and comprehensive credentialing data is maintained in the credentialing software for Health Plan credentialed providers.
8.    Cooperate, as needed, interdepartmentally as well as interdepartmentally, and perform other duties as assigned to support the overall operations within the Credentialing Team.
 


  • Education: High School Diploma
  • Skills: Demonstrated ability to maintain detailed and confidential information.  Familiarity with medical terminology required.
  • Years of Experience: 5-7 years demonstrated experience in provider credentialing processes, preferably in a managed care setting, with working knowledge of NCQA credentialing standards, required
  • Certification: CPCS

 

Preferred Qualifications

  • Education: Associates Degree
  • Skills:  Word processing expertise (Microsoft Word & Excel) and knowledge of Cactus preferred  </li>

 

ProMedica is a mission-based, not-for-profit integrated healthcare organizational headquartered in Toledo, Ohio.  For more information, please visit www.promedica.org/about-promedica

Qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, religion, sex/gender (including pregnancy), sexual orientation, gender identity or gender expression, age, physical or mental disability, military or protected veteran status, citizenship, familial or marital status, genetics, or any other legally protected category. In compliance with the Americans with Disabilities Act Amendment Act (ADAAA), if you have a disability and would like to request an accommodation in order to apply for a job with ProMedica, please contact employment@promedica.org

Equal Opportunity Employer/Drug-Free Workplace

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