Dir Cred & Provider Data Mgt
4.
1 Full-time Full Job Description Where compassion meets innovation and technology and our employees are family.
Thank you for your interest in joining our team! Please review the job information below.
General Purpose of Job:
The Director of Provider Credentialing and Data Management for Driscoll Health Plan provides oversight of Credentialing/Re-credentialing oversight ensuring compliance with DHP policy and in accordance with HHSC, URAC and Texas Department of Insurance requirements.
This position is also responsible for oversight of configuration of Provider Contracts within core DHP systems for Compliance with Contractual agreements including the accuracy of fee schedules, SDA rates, and encounter rates.
Oversees the Provider Data management department which includes oversight of the Provider Change Management process and provider data maintenance activities.
Essential Duties and
Responsibilities:
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily.
The requirements listed below are representative of the knowledge, skill, and/or ability required.
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
This job description is not intended to be all-inclusive; employees will perform other reasonably related business duties as assigned by the immediate supervisor and/or Health Plan administration as required.
Maintains utmost level of confidentiality at all times.
Adheres to hospital policies and procedures.
Demonstrates business practices and personal actions that are ethical and adhere to corporate compliance and integrity guidelines.
Communicates in both written and oral form with contracted professionals, individuals, vendors, and agencies both inside and outside the Health Plan on behalf of the physicians/Health Plan in order to obtain or relay information.
Oversees the Provider Credentialing and Provider Data department which includes oversight of the Credentials Verification Office integration according to HHSC and URAC requirements, oversight of Credentials Process in accordance with DHP policies, oversight of the Provider Change Management process, and provider data maintenance activities.
Maintains oversight of credentialing and Re-credentialing functions, along with Credentialing Manager.
Maintains oversight of credentialing files, along with Credentialing Manager.
Monitors contracts and maintains a file for contracts with providers, ancillary services, hospitals, etc.
Ensures, along with the Privacy Officer, that the Health Plan is compliant with all HIPAA regulations for this department.
Oversees the job performance and provides guidance and maintains TMHP banners and payment updates including fee schedule changes, SDA and encounter rate changes, in regards to questions on payment of claims.
Oversees, as delegated oversight, the loading of Provider information in the claims payment system.
Oversees, as delegated oversight, the loading of Provider contract and rate information in the claims payment system.
Oversees provider communications activities, including Provider Portal content and compliance, provider newsletters, provider fax blasts relating to any health plan activity that require provider notification, and presentation of information on the health plan and provider smart phone application(s).
Oversight and responsibility for accurate and timely updating the Provider Directory on a bi-weekly basis.
Oversight and responsibility for updating the Provider Manual and ensuring appropriate update on the provider portal and provider web-site.
Ensure that business requirements align with credentialing and provider data management systems.
Assists the CEO, CFO, COO, Medical Director(s), Executive Directors, or other staff as needed.
Performs other duties as requested.
Supervisory
Responsibilities:
Effectively administers performance management system including:
developmental feedback goal setting assesses competency progressive discipline Strong knowledge of and effective in administering Health Plan policies and procedures.
Responsible for sound management of human resources.
Makes and implements decisions compatible with organizational goals.
Maintains composure, effectiveness, and flexibility under pressure.
Supervises the following job classes:
Credentialing Manager Provider Data Maintenance team Departmental Administrative Assistant Behavioral Expectations Customer Service - Enthusiastically interacts with all customers.
Assumes personal responsibility for meeting customer needs.
Consistently demonstrates a commitment to customer satisfaction.
Interpersonal Skills- Is sensitive to the needs, ideas, and feelings of others.
Develops and maintains rapport with others.
Listens well.
Facilitates a group process.
Adaptability/flexibility - Demonstrates the ability to change behaviors and plans to meet rapidly changing/ competing job demands (new or unusual situations).
Receives change as a challenge.
Revises plans to meet changing circumstances.
Communication - Clearly and effectively communicates ideas and requests to others.
Persuades or influences others through spoken or written communication.
Initiative - Starts and completes tasks with minimum of prompting.
Willing to make recommendations and assume additional responsibilities.
Team Player - Fully participates in maintaining a positive team environment that is conducive to customer satisfaction.
Builds trust among co-workers, focusing on accomplishing hospital and departmental mission and goals.
Organized and efficient - Organizes work and uses time efficiently.
Takes the initiative to find additional work during slow or downtimes.
Recommends innovative ways of doing work more efficiently and effectively.
Core Values -Practices Driscoll Health System core values.
Education and/or
Experience:
Bachelor's degree (B.
A.
) from four-year college or university; or one to two years related experience and/or training; or equivalent combination of education and experience.
At least 5 years of experience in Managed Care to include experience in Credentialing and/or Provider Data Management.
Estimated Salary: $20 to $28 per hour based on qualifications.
1 Full-time Full Job Description Where compassion meets innovation and technology and our employees are family.
Thank you for your interest in joining our team! Please review the job information below.
General Purpose of Job:
The Director of Provider Credentialing and Data Management for Driscoll Health Plan provides oversight of Credentialing/Re-credentialing oversight ensuring compliance with DHP policy and in accordance with HHSC, URAC and Texas Department of Insurance requirements.
This position is also responsible for oversight of configuration of Provider Contracts within core DHP systems for Compliance with Contractual agreements including the accuracy of fee schedules, SDA rates, and encounter rates.
Oversees the Provider Data management department which includes oversight of the Provider Change Management process and provider data maintenance activities.
Essential Duties and
Responsibilities:
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily.
The requirements listed below are representative of the knowledge, skill, and/or ability required.
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
This job description is not intended to be all-inclusive; employees will perform other reasonably related business duties as assigned by the immediate supervisor and/or Health Plan administration as required.
Maintains utmost level of confidentiality at all times.
Adheres to hospital policies and procedures.
Demonstrates business practices and personal actions that are ethical and adhere to corporate compliance and integrity guidelines.
Communicates in both written and oral form with contracted professionals, individuals, vendors, and agencies both inside and outside the Health Plan on behalf of the physicians/Health Plan in order to obtain or relay information.
Oversees the Provider Credentialing and Provider Data department which includes oversight of the Credentials Verification Office integration according to HHSC and URAC requirements, oversight of Credentials Process in accordance with DHP policies, oversight of the Provider Change Management process, and provider data maintenance activities.
Maintains oversight of credentialing and Re-credentialing functions, along with Credentialing Manager.
Maintains oversight of credentialing files, along with Credentialing Manager.
Monitors contracts and maintains a file for contracts with providers, ancillary services, hospitals, etc.
Ensures, along with the Privacy Officer, that the Health Plan is compliant with all HIPAA regulations for this department.
Oversees the job performance and provides guidance and maintains TMHP banners and payment updates including fee schedule changes, SDA and encounter rate changes, in regards to questions on payment of claims.
Oversees, as delegated oversight, the loading of Provider information in the claims payment system.
Oversees, as delegated oversight, the loading of Provider contract and rate information in the claims payment system.
Oversees provider communications activities, including Provider Portal content and compliance, provider newsletters, provider fax blasts relating to any health plan activity that require provider notification, and presentation of information on the health plan and provider smart phone application(s).
Oversight and responsibility for accurate and timely updating the Provider Directory on a bi-weekly basis.
Oversight and responsibility for updating the Provider Manual and ensuring appropriate update on the provider portal and provider web-site.
Ensure that business requirements align with credentialing and provider data management systems.
Assists the CEO, CFO, COO, Medical Director(s), Executive Directors, or other staff as needed.
Performs other duties as requested.
Supervisory
Responsibilities:
Effectively administers performance management system including:
developmental feedback goal setting assesses competency progressive discipline Strong knowledge of and effective in administering Health Plan policies and procedures.
Responsible for sound management of human resources.
Makes and implements decisions compatible with organizational goals.
Maintains composure, effectiveness, and flexibility under pressure.
Supervises the following job classes:
Credentialing Manager Provider Data Maintenance team Departmental Administrative Assistant Behavioral Expectations Customer Service - Enthusiastically interacts with all customers.
Assumes personal responsibility for meeting customer needs.
Consistently demonstrates a commitment to customer satisfaction.
Interpersonal Skills- Is sensitive to the needs, ideas, and feelings of others.
Develops and maintains rapport with others.
Listens well.
Facilitates a group process.
Adaptability/flexibility - Demonstrates the ability to change behaviors and plans to meet rapidly changing/ competing job demands (new or unusual situations).
Receives change as a challenge.
Revises plans to meet changing circumstances.
Communication - Clearly and effectively communicates ideas and requests to others.
Persuades or influences others through spoken or written communication.
Initiative - Starts and completes tasks with minimum of prompting.
Willing to make recommendations and assume additional responsibilities.
Team Player - Fully participates in maintaining a positive team environment that is conducive to customer satisfaction.
Builds trust among co-workers, focusing on accomplishing hospital and departmental mission and goals.
Organized and efficient - Organizes work and uses time efficiently.
Takes the initiative to find additional work during slow or downtimes.
Recommends innovative ways of doing work more efficiently and effectively.
Core Values -Practices Driscoll Health System core values.
Education and/or
Experience:
Bachelor's degree (B.
A.
) from four-year college or university; or one to two years related experience and/or training; or equivalent combination of education and experience.
At least 5 years of experience in Managed Care to include experience in Credentialing and/or Provider Data Management.
Estimated Salary: $20 to $28 per hour based on qualifications.
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