Job Description

Overview:
To supervise the day-to-day operations of all auditing functions for the PR Department. Provides supervision, support and guidance to the PR Audit staff. Monitors inventory and disseminates work based on timeliness standards and competing priorities. Responsibilities:

• Supervise the daily functions of the Provider Relations Department audit staff.
• Monitor inventory control reports to ensure timeliness standards are being met. Assign or reassign work required to maintain service levels.
• Provide management with weekly updates on the inventory status and recommended actions required to ensure daily functions are adequately addressed.
• Work in collaboration with the Department Supervisors and the PR Trainer to develop and implement training plans for new hires and ensure training progresses according to schedule.
• Oversee the successful completion of ongoing training plans to ensure adequate redundancy for all audit functions.
• Monitor staff productivity, quality, accuracy and service delivery based on performance standards. Ensure regulatory timeliness standards are met consistently.
• Conduct monthly ACD call monitoring for staff.
• Meet monthly with direct report staff to provide performance feedback.
• Support staff development by identifying new training opportunities and shadowing at interdepartmental meetings.
• Maintain updated desk procedures and other resource materials and oversee the timely completion of written procedures by staff as assigned.
• Oversee development, testing and auditing of new audit procedures and tools.
• Interview and participate in selection of PR staff that will directly report to supervisor.
• Write and conduct staff performance evaluations.
• Act as a liaison with internal Partnership Departments to assist with resolving questions relating to provider data and system set-ups.
• Participate in workgroups designed to improve accuracy or support regulatory directives.
• Attend internal and external meetings and participate in or recommends solutions to issues.
• Participate in delegated credentialing oversight, including annual audits.
• Recommend process improvements designed to improve efficiency.
• Promote a positive attitude, teamwork and fun in the workplace.
• Other duties as assigned.

Qualifications:
Education and Experience
Bachelor's degree in Healthcare, Business, or related field; and minimum three (3) years of experience in healthcare, credentialing, provider data, or provider systems; or equivalent combination of education and experience. Previous supervisory experience a plus.
Special Skills, Licenses and Certifications
Working knowledge of business software applications. Knowledge of managed care concepts, NCQA Credentialing Standards and Network Standards relating to provider directories. Ability to implement Medi-Cal policies and procedures and All Plan Letters. Ability to demonstrate subject matter expertise in provider systems, data and credentialing. Valid California driver's license and proof of current automobile insurance compliant with Partnership policy are required to operate a vehicle and travel for company business.
Performance Based Competencies
Excellent oral and written communication skills. Excellent organization skills with the ability to prioritize assignments, maintain accurate records, and meet deadlines. Ability to interpret and understand complex technical and regulatory requirements. Ability to use good judgment in making decisions within scope of authority and handle sensitive issues with tact and diplomacy.
Work Environment And Physical Demands
Ability to use a computer keyboard. More than 30% of work time is spent in front of a computer monitor. When required, ability to move, carry, or lift objects of varying size, weighing up to 35 lbs. Ability to work in a fast paced environment with frequent interruptions and multiple competing deadlines.
All HealthPlan employees are expected to:

• Provide the highest possible level of service to clients;
• Promote teamwork and cooperative effort among employees;
• Maintain safe practices; and
• Abide by the HealthPlan's policies and procedures, as they may from time to time be updated.

HIRING RANGE:
$ 93,690.86 - $117,113.58
IMPORTANT DISCLAIMER NOTICE
The job duties, elements, responsibilities, skills, functions, experience, educational factors and the requirements and conditions listed in this job description are representative only and not exhaustive or definitive of the tasks that an employee may be required to perform. The employer reserves the right to revise this job description at any time and to require employees to perform other tasks as circumstances or conditions of its business, competitive considerations, or work environment change.

Skills Required