Sr Mgr Provider Admin & Credentialing

At HCSC, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers.

Join HCSC and be part of a purpose-driven company that will invest in your professional development.

Job Summary

SUMMARY: This position is responsible for managing the credentialing process in compliance with agency regulations (Department of Insurance, CMS, DOD/TriCare, NCQA and URAC), managing the process of collection and maintenance of professional provider data, and managing credentialing audits. This position is responsible for the development, implementation and maintenance of policies, procedures, workflow processes and developing departmental goals, ensuring the departments meets or exceeds goals, and operational effectiveness. Develop performance standards, monitor and analyze unit production and quality statistics to ensure achievement of goals while ensuring personnel resources are appropriately allocated. Participate as a Lead in monthly Provider Network Committee and quarterly Institutional Provider Workgroup meetings, working with Vice Presidents, Directors and Managers from across state and the Enterprise to address issues and improve processes.

JOB REQUIREMENTS:

• Bachelor’s Degree and 7 years’ experience in a managed care provider contracting, network management or credentialing OR 11 years’ experience in a managed care provider contracting, network management or credentialing
• Must have 3 years management experience.
• Management skills to cultivate a creative, supportive and innovative environment.
• Coaching and training skills.
• Experience in a production environment with a focus on operations, state and federal regulations, industry standards and quality concepts.
• Experience developing, implementing and managing projects and programs.
• Experience developing and implementing policies, procedures, processes, and workflows.
• Knowledge of NCQA, URAC, CMS, and state Department of Insurance regulatory requirements.
• Analytical skills and experience identifying and resolving workflow and system problems.
• Written, verbal and interpersonal communication skills.
• Ability to present clear, concise and accurate information.
• Ability to facilitate diverse groups and build relationships with employees and external customers.

PREFERRED JOB REQUIREMENTS:

• Proficiency in data tools (Excel, PowerBI, data mining, data reporting) - HIGH PREFERRED
• Knowledge of HCSC provider systems.
• Experience developing innovative solutions to ensure objectives are accomplished.

Sponsorship will not be provided for this role.

This is a Telecommute (Remote) role.

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Pay Transparency Statement:

At Health Care Service Corporation, you will be part of an organization committed to offering meaningful benefits to our employees to support their life outside of work. From health and wellness benefits, 401(k) savings plan, pension plan, paid time off, paid parental leave, disability insurance, supplemental life insurance, employee assistance program, paid holidays, tuition reimbursement, plus other incentives, we offer a robust total rewards package for employees. Learn more about our benefit offerings by visiting .

The compensation offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plan subject to the terms and the conditions of the plan.

This position may be performed remotely from anywhere within the continental United States, excluding California, New York, Alaska, and Hawaii .

HCSC Employment Statement:

Base Pay Range

$92,700.00 - $167,500.00

Exact compensation may vary based on skills, experience, and location.

Originally posted on Himalayas