Upper Peninsula Health Plan (UPHP) · 1 day ago
Credentialing Manager
Marquette, MI
Full-time
Onsite
Mid, Senior Level
3+ years expUpper Peninsula Health Plan is seeking a Credentialing Manager to oversee the development, management, and monitoring of all credentialing and re-credentialing processes. This role involves ensuring compliance with accrediting and regulatory agencies, training and supervising staff, and supporting various committees within the organization.
Health CareHealth InsuranceMedical
Responsibilities
Follows established Upper Peninsula Health Plan (UPHP) policies and procedures, objectives, safety standards, and sensitivity to confidential information
Performs all supervisory functions of assigned staff to include scheduling of time off, 90-day and annual performance appraisals, and other appropriate evaluations in compliance with UPHP employee policies; responsible for delegating work among the team, problem solving, and motivating and supporting the credentialing team so they may achieve peak productivity and performance
Obtains and maintains National Committee for Quality Assurance (NCQA) certification for the CVO and health plan accreditation as applicable
Develops, implements, and markets CVO services to hospitals and identifies other CVO growth opportunities
Develops, implements, revises, and adheres to established policies, procedures, and objectives to ensure credentialing is in compliance with all licensing standards and accrediting organizations including NCQA, The Joint Commission (JC), Michigan Department of Health and Human Services (MDHHS), Department of Insurance and Financial Services (DIFS), and Centers for Medicare and Medicaid Services (CMS)
Monitors reports, files, and other output to ensure the team meets key performance indicators with a continued focus on delivering high quality services with efficiency
Ensures applications for provider membership and reappointment are processed in accordance with UPHP Policy
Maintains accurate and up to date information in the credentialing database and supervises an annual audit of the database, as well as audits by NCQA, MDHHS, CMS, CVO clients, and commercial payer networks
Compiles credentialing reports as necessary for the Credentialing Committee, Management Committee, CEO, COO, medical director, claims, and clinical services
Works collaboratively with other internal departments including, but not limited to, provider relations and government programs to ensure effective integration and communication of credentialing requirements and other matters as appropriate
Responsible for maintaining all applicable lists/logs of licenses, insurance, board certification of UPHP providers, and ensures that all providers are screened as required, including but not limited to, review of sanctioned providers from the Medical Services Administration (MSA), Office of Inspector General (OIG), and the Department of Licensing and Regulatory Affairs (LARA)
Undertakes special projects and assignments and attends meetings as necessary; chairs or participates on committees as requested
Maintains confidentiality of client data
Performs other related duties as assigned or requested
Qualification
Required
Associate degree in business, health information processing, health information systems, or related field
Three (3) to four (4) years of progressive office experience
Working knowledge of MS Office (Word, Excel, and PowerPoint)
Keyboarding proficiency
Excellent human relation and oral/written communication
Excellent organizational skills with attention to detail
Ability to work independently and to prioritize tasks
Ability to access departmental files
Ability to enter and access information from a computer
Ability to access all areas of the UPHP offices
Moderate physical effort (lift/carry up to 25 pounds)
Occasionally lifts supplies/equipment
Occasional reaching, stooping, bending, kneeling, crouching
Prolonged periods of sitting
Occasional prolonged standing
Manual dexterity and mobility
Works in office conditions, but occasional travel may be required
Subject to many interruptions
Occasionally subjected to irregular hours and evening meetings
Preferred
Bachelor's degree in office or business administration or health care-related area
NAMSS Certification as a Certified Provider Credentialing Specialist (CPCS)
Three (3) to four (4) years of credentialing and/or management experience
Previous supervisory experience
Company
Upper Peninsula Health Plan (UPHP)
Mission Statement The mission of UPHP is to be an innovative health plan managing the care of our members in the Upper Peninsula guiding them to quality, cost-effective care through our network of providers improving the overall health of the communities we serve.
51-200 employees
Funding
Current Stage
Growth StageCompany data provided by crunchbase