Location: all cities,OH, USA
Note, this is a remote opportunity. Eastern & Central Time Zones preferred.
Founded in 1934, Medical Mutual is the oldest and one of the largest health insurance companies based in Ohio. We provide peace of mind to more than 1.2 million members through our high-quality health, life, disability, dental, vision and indemnity plans. We offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement, and individual plans.
Supervises the daily workflow of the Credentialing and Provider Data departments, ensuring efficiency and accuracy of work and compliance with all organizational, regulatory, and accrediting body standards and policies. Collaborates with management and staff to develop training programs, policies, and procedures. Supervises the integrity of the provider data contained in the provider data management system.
Responsibilities
* Supervises operations and staff engaged in the review, audit, and validation of applications and/or provider data. Communicates and monitors expectations and outcomes and evaluates individual and team performance. Supervises staff by providing coaching and guidance in specific areas related to overall job performance and accountability.
* Facilitates the management of credentialing and provider information loading processes and inventory control.
* Develops, communicates, and enforces standard operating procedures for the department to ensure timely and accurate credentialing and updating of provider demographic data and contract maintenance to ensure prompt and accurate payment to providers.
* Generates reports from system for monitoring of work queue and aging inventory. Trends errors, identifies opportunities, and develops training programs. Works with internal departments to review, trend, and answer and document, credentialing, and system issues.
* Researches, develops, and maintains guidelines for all provider specialty types in adherence with all organizational, regulatory, and accrediting body policies and procedures.
* Regularly communicates with internal departments and external provider groups regarding credentialing status and other provider related information.
* Leads maintaining readiness for NCQA accreditation and regulatory surveys. Prepares reports/documents, assists with on-line reviews and post-survey follow-up activities.
* Performs other duties as assigned.
Qualifications
* Bachelor's degree in business or healthcare administration or related field.
* In lieu of degree, may consider equivalent combination of education/training and experience.
* 7 years progressive provider credentialing and/or data or equivalent experience in a health plan, medical office, hospital, or similar administration, which includes team lead or supervisory experience.
* Certified Provider Credentialing Specialist (CPCS) preferred.
* Intermediate to advanced Microsoft Office (Word, Excel), database reporting, OnBase (document management system), and internet navigation skills. Proficiency with credentialing software such as Vistar, CACTUS.
* Advanced knowledge of provider credentialing and/or database management procedures and regulatory standards such as NCQA, CMS, ODI and other regulatory bodies and the ability to apply to business operations.
* Excellent knowledge of healthcare industry terminology.
* Ability to interpret data into meaningful reports / documentation and communicate findings to others.
* Ability to lead a production-based team and manage file inventory and prioritize workloads.
* Ability to communicate with various internal and external contacts.
* Ability to multi-task.
Medical Mutual is looking to grow our team! We truly value and respect the talents and abilities of all of our employees. That's why we offer an exceptional package that includes:
A Great Place to Work:
* We will provide the equipment you need for this role, including a laptop, monitors, keyboard, mouse and headset.
* Whether you are working remote or in the office, employees have access to on-site fitness centers at many locations, or a gym membership reimbursement when there is no Medical Mutual facility available. Enjoy the use of weights, cardio machines, locker rooms, classes and more.
* On-site cafeteria, serving hot breakfast and lunch, at the Brooklyn, OH headquarters.
* Discounts at many places in and around town, just for being a Medical Mutual team member.
* The opportunity to earn cash rewards for shopping with our customers.
* Business casual attire, including jeans.
Excellent Benefits and Compensation:
* Employee bonus program.
* 401(k) with company match up to 4% and an additional company contribution.
* Health Savings Account with a company matching contribution.
* Excellent medical, dental, vision, life and disability insurance - insurance is what we do best, and we make affordable coverage for our team a priority.
* Access to an Employee Assistance Program, which includes professional counseling, personal and professional coaching, self-help resources and assistance with work/life benefits.
* Company holidays and up to 16 PTO days during the first year of employment with options to carry over unused PTO time.
* After 120 days of service, parental leave for eligible employees who become parents through maternity, paternity or adoption.
An Investment in You:
* Career development programs and classes.
* Mentoring and coaching to help you advance in your career.
* Tuition reimbursement up to $5,250 per year, the IRS maximum.
* Diverse, inclusive and welcoming culture with Business Resource Groups.
About Medical Mutual:
Medical Mutual's status as a mutual company means we are owned by our policyholders, not stockholders, so we don't answer to Wall Street analysts or pay dividends to investors. Instead, we focus on developing products and services that allow us to better serve our customers and the communities around us.
There's a good chance you already know many of our Medical Mutual customers. As the official insurer of everything you love, we are trusted by businesses and nonprofit organizations throughout Ohio to provide high-quality health, life, disability, dental, vision and indemnity plans. We offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement and individual plans. Our plans provide peace of mind to more than 1.2 million Ohioans.
We're not just one of the largest health insurance companies based in Ohio, we're also the longest running. Founded in 1934, we're proud of our rich history with the communities where we live and work.
At Medical Mutual and its family of companies we celebrate differences and are mutually invested in our employees and our community. We are proud to be an Equal Employment Opportunity and Affirmative Action Employer. Qualified applicants will receive consideration for employment regardless of race, color, religion, sex, sexual orientation, gender perception or identity, national origin, age, marital status, veteran status, or disability status.
We maintain a drug-free workplace and perform pre-employment substance abuse and nicotine testing.