Provider Enrollment and Credentialing Supervisor - 1901482
The Provider Enrollment and Credentialing Supervisor will supervise the staff that facilitates the securing, verifying, compiling, and forwarding of such qualifying information to health plans and payors . Clinical providers cannot perform services for health plan and payor members, and receive payment for same, without validation and verification of a variety of licensure, clinical, academic and regulatory qualifications. The Provider Enrollment and Credentialing Supervisor will work with the Assistant Director of Managed Care as well as other Enrollment and Credentialing Specialists.
Duties of the Provider Enrollment and Credentialing Supervisor may include the following but are not limited to:
Supervise Provider Enrollment and Credentialing Unit
Coordinates Delegated Credentialing Audit with health plan and Medical Staff Office - Review audit results to identify opportunities of improvement and implement suggested and required changes
Communicates onboarding issues to health plans, including loading delays and inaccurate information in plan's systems and directories and coordinates with health plans and internal departments (Medical Staff Office, Managed Care Contracting, UFPC or medical group) to resolve those issues
Plan, organize, coordinate and manage the daily onboarding activities to ensure accurate and timely completion of the onboarding process
Maintains current knowledge of NCQA, CMS, NYSDOH, TJC regulations and ensures policies and procedures meet or exceed these requirements and educates staff on changes and updates to ensure compliance
Negotiates delegated credentialing agreements and review and submits contract language changes as needed to ensure all agreements are in compliance with NCQA, CMS, NYSDOH, TJC and Medical Staff Office policies and procedures
Manages and administers onboarding database
Develops, audits and oversees maintenance of individual Provider Participation Matrix to provide accurate, up to date enrollment status and distributes the matrix with updates to offices and central departments
Attends required meetings and participates in training programs as required; participates in a variety of professional activities
Other duties as assigned
Required Qualifications: Bachelor's degree. F ive (5) or more years direct supervisory experience in credentialing and enrolling clinical healthcare professionals, either on behalf of a healthcare provider of moderate or significant size or on behalf of a health plan or payor. Possess in-depth knowledge of regulatory, clinical and legal requirements for enrollment of providers, including but not limited to those of the State of New York, Medicare/Medicaid, The Joint Commission (TJC) and the National Committee for Quality Assurance (NCQA). Experience in onboarding and credentialing clinical providers, including physicians, within a health care delivery organization or on behalf of a health care plan or payor, such as a managed care organization, in accordance with guidelines of the National Committee for Quality Assurance (NCQA), Center for Medicare and Medicaid Services (CMS), New York State Department of Health (NYSDOH) and The Joint Commission (TJC) and all other regulatory standards as required in the delegation agreements with contracted health plans
Preferred Qualifications: Enrollment and credentialing experience on behalf of a health care delivery system (hospital or physician practice group), particularly an academic medical center. Experience with CACTUS or similar database software.
Special Notes: The Search Committee will begin the review of applications on 05/15/19 and continue until the position is filled.
Stony Brook Medicine is a smoke free environment. Smoking is strictly prohibited anywhere on campus, including parking lots and outdoor areas on the premises.
All Hospital positions are subject to changes in pass days and shifts as necessary. This position may require the wearing of respiratory protection, which may prohibit the wearing of facial hair.
The selected candidate must successfully clear a background investigation. Prior to start date, the selected candidate must meet the following requirements: Successfully complete pre-employment physical examination and obtain medical clearance from Stony Brook Medicine's Employee Health Services (The hiring department will be responsible for any fee incurred for examination), submit (3) written references, and provide a copy of any required New York State license(s)/certificate(s). Please be advised that failure to comply with any of the above requirements could result in a delayed start date and/or revocation of the employment offer.
About Stony Brook Medicine:
The best ideas in medicine start with the best people. At Stony Brook Medicine, our highest calling is to put the power of ideas to work in our patients' lives. Stony Brook Medicine integrates and elevates all of our health-related initiatives: education, research and patient care. Stony Brook Medicine is Long Island's premier academic medical center. With 603 beds, we serve as the region's only tertiary care center and Level 1 Trauma Center, and are home to the Stony Brook Heart Institute, Stony Brook Cancer Center, Stony Brook Children's Hospital, Stony Brook Neurosciences Institute, and Stony Brook Digestive Disorders Institute. We also encompass Suffolk County's only Level 4 Regional Perinatal Center, state-designated AIDS Center, state-designated Comprehensive Psychiatric Emergency Program, state-designated Burn Center, the Christopher Pendergast ALS Center of Excellence, and Kidney Transplant Center. It is home of the nation's first Pediatric Multiple Sclerosis Center.
Stony Brook University is an Affirmative Action/Equal Opportunity employer. We are committed to the creation of a diverse and inclusive campus climate. We encourage protected veterans, individuals with disabilities, women and minorities to apply.
This function/position has been designated as
Internal Number: 1901482
About Stony Brook University
FROM ITS BEGINNINGS A HALF-CENTURY AGO, STONY BROOK UNIVERSITY HAS BEEN CHARACTERIZED by innovation, energy and progress, transforming the lives of people who earn degrees, work and make groundbreaking discoveries here. A dramatic trajectory of growth has turned what was once a small teacher preparation college into an internationally recognized research institution that is changing the world.