Credentialing Supervisor - 153386
Community Health Choice, Inc. (Community) is a non-profit managed care organization (MCO), licensed by the Texas Department of Insurance. Through its network of more than 10,000 providers and 94 hospitals, Community serves over 400,000 Members with the following programs:
• Medicaid State of Texas Access Reform (STAR) program for low-income children and pregnant women.
• Children’s Health Insurance Program (CHIP) for the children of low-income parents, which includes CHIP Perinatal benefits for unborn children of pregnant women who do not qualify for Medicaid STAR
• Health Insurance Marketplace Plans that offer individual health coverage that includes preventive care, emergency services, prescription drugs, and hospitalization available to all, regardless of pre-existing conditions.
Improving Members' experiences is at the heart of every Community position. We strive every day to make sure that our Members have access to the high-quality health care they need and deserve.
Community is accredited by URAC for its health plan operations. We offer care management programs for asthma, diabetes, and high-risk pregnancy. An affiliate of the Harris Health System (Harris Health), Community is financially self-sufficient and receives no financial support from Harris Health or from Harris County taxpayers.
The Credentialing Supervisor is responsible for: supervising the credentialing staff in all of their duties, including maintaining initial credentialing, re-credentialing and the continuous credentialing processes for Individual and Organizational Providers; maintaining the integrity, accuracy and completion of Provider data in credentialing files and database; complying with regulatory and accreditation standards and performance expectations related to credentialing quality control, delegation oversight, departmental and personal improvement goals; and interacting with Medical Directors and organizational leaders internally/externally to resolve credentialing and provider data issues.
- High school graduation required; Degree preferred.
- NAMSS Certification (CPCS or CPMSM) strongly preferred or eligibility to acquire within 12 months after date of hire
- Three years of healthcare practitioner credentialing experience in a managed care setting required
- Two years supervisory experience preferred
- Writing /Composing: Correspondence /Reports)
- Analytical, Mathematics, Medical Terminology, Research, Statistical
- Demonstration of good communication and interpersonal skills,
- Credentialing Software System (Cactus experience preferred), Adobe Pro, Laserfiche
Benefits and EEOC
Community employees’ benefits are provided by Harris Health. These benefits are designed to provide you with flexibility and choices in meeting your specific needs.
Community is an Equal Opportunity Employer.