Supervisor, Provider Operations
Location: Milwaukee, Wisconsin, United States
Remote Opportunity: 0
Requisition Number: 2575
Position Title: Supervisor, Provider Enrollment & Cred
The Provider Enrollment & Credentialing Supervisor manages and monitors staff and systems which support the accurate and timely tracking and monitoring of provider related enrollment and credentialing activities.
PRIMARY JOB RESPONSIBILITIES:
• Oversee enrollment and credentialing of Providers in accordance with requirements (NCQA, CMS, etc.).
• Ensure DentaQuest’s credentialing process meets client expectations and state regulations.
• Assist with delegated credentialing audits as needed.
• Ensure all Applications and Site Reviews are tracked.
• Ensure reports are prepared accurately, timely and work to automate the reports where applicable.
• Allocate resources appropriately to meet deadlines.
• Ensure adequate coverage of site reviewers where required.
• Participate in the determination and implementation of corrective action plans.
• Provide recommended solutions to credentialing issues and changes in requirements.
• Assist in resolving complaints and issues with providers.
• Aid in answering Request for Proposal (RFP) questions.
• Provide consultative services to proactively meet customer needs, using management reports and trend analysis.
• Organize workflow between other departments to ensure efficient and accurate outcomes.
• Coordinate and implement appropriate performance management strategies for team members to include:
o Assist in the hiring process, including interviewing candidates.
o Assist, train and motivate team members.
o Assist in preparation of performance and wage evaluations in accordance to company policy.
o Responsible for attendance and company approved time off for team members.
o Participate in the determination and implementation of Performance Improvement Plans and performance management initiatives.
o Create efficiencies with the department.
• Update management team as appropriate on major issues, both internal and external.
• Other duties as assigned.
• Bachelor’s degree in Health Care or relevant field, preferred.
• 3+ years of supervisory experience required.
• Knowledge of NCQA, CMS and other quality requirements preferred.
• Excellent PC skills with proficiency in MS Office products.
• Excellent oral and written communication skills.
• Strong customer service and analytical skills.
• Strong Project management and process improvement skills.
• Ability to manage staff and work well with others.
• Ability to prioritize and organize multiple tasks and remain organized with multiple interruptions.
• Ability to meet multiple deadlines.
• Ability to work in excess of 40 hours per week, as needed or required to meet business objectives.
• Ability to travel (<5%).
• Requires the effective use of all office equipment including, but not limited to, telephone, computers, printers, scanners and fax machines.
• The position is located in a wheelchair accessible building.
The specific statements shown in each section of this description are not intended to be all-inclusive. They represent typical elements and criteria necessary to successfully perform this position.
** In accordance with DentaQuest’s Compliance Plan, employee must conduct DQ business in accordance with applicable laws, regulations, professional standards and ethical standards and report potential compliance or ethical issues to manager or DQ’s Compliance Officer. **
DentaQuest’s Affirmative Action Program affirms our commitment to make reasonable accommodation to the known physical or mental limitation of otherwise-qualified individuals with disabilities or special disabled veterans, unless the accommodation would impose an undue hardship on the operation of our business. Please see Human Resources for additional information regarding this Program.
Community / Marketing Title: Supervisor, Provider Operations
At DentaQuest, we believe that everyone should live life free of dental disease. As a purpose-driven, double bottom line company that is improving oral health for everyone, we are transforming the oral health system – from the way we provide care and pay for it, to how we talk about it and prioritize it in our policies and communities.
Meaningful change requires a revolution in oral health. We are redefining what it means to prevent disease and provide better access to care for everyone. We are going beyond the dental chair to reshape the oral health system, addressing total health and the social and cultural factors that impact it.
To make this revolution a reality, we harness our unique reach and insights to advance policy, financing, care, and the community. That means solving problems in a flexible and efficient way, testing and trialing to create new solutions and delivering measurable outcomes for the people we serve.
The people of DentaQuest have a common purpose, and we work together with passion, perseverance and focus to achieve a nation where no child suffers from the pain of tooth decay. Where adults keep all their teeth for their entire lives. Where every person has access to quality dental care.
Location_formattedLocationLong: Milwaukee, Wisconsin US
CountryEEOText_Description: Equal Employment Opportunity Statement: DentaQuest is committed to a policy of nondiscrimination and equal opportunity for all employees and qualified applicants without regard to race, color, religious creed, national origin, sex, age, disability, marital status, or sexual orientation.