AmeriHealth Caritas Credentialing Supervisor in Philadelphia, Pennsylvania

Credentialing Supervisor

Location: Philadelphia, PA

Telecommuter?: No

ID**: 16225

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:

  • Ensure compliance with all state regulations and NCQA standards related to credentialing and recredentialing, including all departmental coordination, communication, education, committee structure, and support.

  • Monitor productivity and ensure timely completion of files for both practitioners and organizational providers.

  • Knowledge of Primary Source Verification for all provider types.

  • Preparation of routine and non-routine provider files for Medical Director and Credentialing Committee review.

  • Track and trend auditor findings and administer appropriate staff education.

  • Maintain historical credentialing records.

  • Participate on inter-disciplinary committees to maintain and understand the scope of projects and policies and procedures and the impact to the credentialing process.

  • Participate in the annual HEDIS process in conjunction with the Quality Improvement staff.

  • Participate in the preparation of all oversight activities related to all internal and external audits.

  • Coordinate the data entry for the Plan’s delegated Practitioners.

  • Communicate effectively with departmental leadership regarding details surrounding assignments, prioritization, and/or other duties assigned.

  • Adhere to the organization’s code of confidentiality.

  • Supports and carries out the Mercy Mission and Values.

  • Perform other duties as assigned by department manager.

Education/Experience:

  • Bachelor’s Degree or the equivalent work experience.

  • Three to five years managed care and credentialing experience required.

  • Two or more years proven supervisor, management or team leadership skills required.

EOE Minorities/Females/Protected Veterans/Disabled