Credentialing Supervisor

What we need

The Credentialing Supervisor will report to the Senior Credentialing Manager, Compliance Consultant to oversee a team of 9 credentialing associates as well as temporary staff as needed. The Credentialing Supervisor will be primarily accountable for inventory assignments and handling escalated/priority requests. The Supervisor will be responsible for ensuring day-to-day operations within the Team as well as updates on progress to goals, workflow updates, and continuous review of research tools. These tools may include but are not limited to the BCBSMA credentialing systems and documentation in conjunction with current Credentials & Peer Review Committee (CPRC) policies, state and federal regulations and National Committee on Quality Assurance (NCQA) accreditation standards. By efficiently and effectively partnering with the Senior Credentialing Manager/Compliance Consultant, the Credentialing Supervisor role will also participate, drive, and support discussions, forums, and workgroups.

Your Day to Day

This document is not an exhaustive list of all responsibilities, skills, duties, requirements, or working conditions associated with the job.

• Mentor/Train newer associates, including temporary staff, offering guidance on workflows, complex issues, and communications/action steps to improve the quality and accuracy of transactions.
• Be actively involved with the team members, provide support by responding to Associate questions in a timely manner and working inventories, as needed.
• Discuss policy changes with Leader to effectively communicate policy changes/updates to Associates.
• Partner with Network Management and other BCBSMA subject matter experts to ensure workflows and associate research tools are updated with the most recent policy information.
• Support Provider Operations teams including the Network Management Service (NMS) and Provider Directory teams with credentialing and peer review processes.
• Delegate work assignments to appropriate resources and follow up on status of activities.
• Utilize analytical skills to identify root cause of issues/pursues corrective action with guidance of the Leader.
• Participate in special projects as needed and consistently meet deliverable deadlines.
• Communicate key information to leadership on the day-to-day team activities and consistently suggest process improvements.
• Share information and work in collaboration with other teams towards improving (re) credentialing processing times.
• Assist with developing team members to the fullest potential and identify opportunities for cross training.
• Provide recommendations to improve performance and quality within the department.
• Oversee privileging responsibilities.
• Produce and coordinate task and interface monitoring reports under the direction of the Leader.

We are Looking for a candidate who possesses:

• Strong technical aptitude and advanced working knowledge of provider data systems (HURN, ADMIN, CACTUS, Sharepoint) and/or provider directories a definite plus.
• Strong analytical skills and ability to interpret and communicate data.
• Excellent verbal and written communication skills.
• Excellent time management skills and ability to plan and set priorities.
• Knowledge of all federal & state regulations and accreditation standards.

• Excellent people skills, tact, diplomacy, flexibility, and patience.
• Detail orientation, proven organization and time management skills and ability to quickly adapt to changing priorities.
• Experience working in matrix organization.

What You Bring:

• Bachelor's degree required but may consider combination of education and business experience related to job responsibilities and qualifications.
• Provider Credentialing Specialist Certification (CPCS) by the National Association Medical Staff Services (NAMSS) or ability to become certified within two (2) years of hire date, required.
• 2-4 years successful leadership experience including coaching and mentoring associates
• Demonstrated supervisory skills including the ability to negotiate and influence others.
• Demonstrated business understanding of the health insurance industry, Quality Assurance programs and Credentials & Peer Review.
• Proven ability to coach, mentor, develop and influence others
• Demonstrated proficiency in Microsoft applications
• Demonstrated self-development and professional development efforts.

This role is eligible for our eWorker, Mobile, and Resident personas. This position can be fully remote, with expectations to work in our Hingham, MA office 1-3x per month.

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What You will Gain:

• Contribution to the Credentials & Peer Review mission to support the delivery of high-quality, cost-effective health care for our members by ensuring BCBSMA offers a qualified network of providers through nationally recognized (re)credentialing and peer review standards.
• Opportunity to be in an inclusive and rewarding workplace that promotes excellence and provides opportunities for associates to forge their unique career path. Recognition that you are a subject matter expert in all matters concerning (re) credentialing and peer review.
• Increased potential for advancement in any healthcare environment.

High school degree or equivalent required unless otherwise noted above

The job posting range is the lowest to highest salary we in good faith believe we would pay for this role at the time of this posting. We may ultimately pay more or less than the posted range, and the range may be modified in the future. An employee's pay position within the salary range will be based on several factors including, but limited to, relevant education, qualifications, certifications, experience, skills, performance, shift, travel requirements, sales or revenue-based metrics, and business or organizational needs and affordability.

This job is also eligible for variable pay.

We offer comprehensive package of benefits including paid time off, medical/dental/vision insurance, 401(k), and a suite of well-being benefits to eligible employees.

Note: No amount of pay is considered to be wages or compensation until such amount is earned, vested, and determinable. The amount and availability of any bonus, commission, or any other form of compensation that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law.

WHY Blue Cross Blue Shield of MA?

We understand that theconfidence gapandimposter syndromecan prevent amazing candidates coming our way, so please don't hesitate to apply. We'd love to hear from you. You might be just what we need for this role or possibly another one at Blue Cross Blue Shield of MA. The more voices we have represented and amplified in our business, the more we will all thrive, contribute, and be brilliant. We encourage you to bring us your true colors, , your perspectives, and your experiences. It's in our differences that we will remain relentless in our pursuit to transform healthcare for ALL.

As an employer, we are committed to investing in your development and providing the necessary resources to enable your success. Learn how we are dedicated to creating an inclusive and rewarding workplace that promotes excellence and provides opportunities for employees to forge their unique career path by visiting ourCompany Culturepage. If this sounds like something you'd like to be a part of, we'd love to hear from you. You can also join ourTalent Communityto stay "in the know" on all things Blue.

At Blue Cross Blue Shield of Massachusetts, we believe in wellness and that work/life balance is a key part of associate wellbeing. For more information on how we work and support that work/life balance visit our "How We Work" Page.