Credentialing, Privileging & Enrollment Supervisor

Care Stream: Human Resources & Clinical Staff Office

LIA Reporting Structure:

Timecard Approver: VP of Ambulatory Care & Medical Services

Primary: Chief Human Resources Officer

Secondary: Chief Health Officer

Status: Full-Time

FLSA: Exempt

Location: Expo

Pay Range: $95,680-$108,500/yr

Organization Information

WellSpace's mission is "achieving regional health through high quality comprehensive care." We believe that everyone deserves to be seen, no matter who you are, where you come from, where you work or what place you call home. At WellSpace, we see you!

We are driven to serve the whole person through comprehensive, integrated care, spanning medical, dental, behavioral health, and supportive services across the region. We do this by building a team of exceptional colleagues who are dedicated to our mission and becoming part of the communities we serve.

As the region's largest Community Health System, WellSpace utilizes a Confluence Model to integrate an internal network of healthcare modalities, including Federally Qualified Health Centers (FQHC), Certified Community Behavioral Health Center (CCBHC), Drug Medi-Cal and Specialty Mental Health programs, California's second largest 988 Suicide and Crisis Lifeline Center, an independent Risk Bearing Organization (WellSpace Nexus), and more into a seamless confluence of care.

To ensure the highest quality of care, WellSpace is accredited by the Joint Commission for Ambulatory Care, Behavioral Health and as a CCBHC. Further, it is certified by the Joint Commission as a Primary Care Medical Home and a Behavioral Health Home. WellSpace's crisis programs are accredited by the American Association of Suicidology and the International Council for Helplines.

Position Summary

The Credentialing & Privileging Supervisor oversees the full lifecycle of provider credentialing, recredentialing, and privileging for all licensed, certified and other clinical staff. This role ensures compliance with California regulations, HRSA FTCA requirements, Medicare/Medicaid enrollment, payer credentialing, and NCQA/Joint Commission standards. The supervisor leads credentialing staff, manages workflows, ensures data accuracy, and collaborates with leadership, providers, and external agencies to maintain timely and compliant credentialing processes.

Required Qualifications

• Bachelor’s degree in business or healthcare administration or related field or 5 years’ experience in hospital and/or healthcare credentialing in lieu of education
• Preferred Medical Staff Services certification: Certified Professional Medical Services Management (CPMSM), Certified Provider Credentialing Specialist (CPCS) or Certified Professional Medical Services Management (CPMSM) credential from National Association Medical Staff Services (NAMSS).
• Knowledge of credentialing rules and regulations, as well as accrediting organization standards, Center for Medicare and Medicaid Services (CMS) regulations, state regulations and other regulatory agencies as they pertain to medical staff and allied health professionals
• Knowledge and experience with audits from TJC, FTCA, plans/IPA, etc.
• Minimum five (5) years of supervisory or lead experience in credentialing
• Demonstrated ability to supervise up to 5 employees
• Experience working in Human Resources department
• Able to communicate effectively in English, both verbally and in writing
• Fluency in additional languages preferred
• Excellent interpersonal skills
• Knowledge of basic anatomy and physiology, medical terminology and functions of medical staff services
• Advanced computer skills in word processing, spreadsheets and databases
• Excellent organizational skills
• Must be willing to successfully complete the credentialing process.

Essential Responsibilities

• Oversees the credentialing & privileging process to ensure that all individuals credentialed and/or granted clinical privileges are qualified to provide patient care, treatment and services based upon the scope of their training, licensure and experience.
• Supervises the Credentialing & Enrollment team to ensure optimum performance of the department.
• Functions as a member of Human Resources and acts as the subject matter expert for credentialing, privileging and enrollment.
• Ensures compliance with rules and regulations, allied health professional's policies, other policies and procedures and appropriate regulatory agency standards.
• Audits, supervises and evaluates processes involved in verifications for licensed and certified providers and allied health professional’s application, and evaluates processes involved in verifications for licensed and certified providers and allied health professionals’ appointments, reappointments, appointments reappointment and privilege delineation.
• Coordinates the processing of candidates’ applications that require credentialing & privileging. Assures that all applications are processed completely and in a timely manner in accordance with HR guidelines.
• Audits applications, reviews supporting documents, including all primary source verification for all credentialing and re-credentialing to ensure allied health professional files are current and policies and procedures are followed to obtain required documentation and verification.
• Coordinates activities, provides statistical information and explains procedures to facilitate the reappointment process.
• Maintains and monitors confidential information for credentialing, HR, and peer review discussions and other sensitive matters.
• Organizes and supports the Credentialing Committee.
• Responsible for assuring that the findings, conclusions and recommendations for actions to appoint or reappointment applicants and/or improve the credentialing program are reported through appropriate leadership, and that approved actions are then assigned and/or implemented in a timely manner.
• Improves professional growth, knowledge of job to maintain efficiency and effectiveness of the Credentialing department by belonging to professional organizations, attending seminars, and reading journals and publications.
• Assures the ongoing development and implementation of policies and procedures that guide and support the provision of services.
• Possesses working knowledge of state and federal law relating to due process and provisions of the Health Insurance Portability and Accountability Act (HIPAA) of 1996 and accrediting organization standards.
• Supports and maintains a culture of safety and quality.
• Other duties as assigned.

Benefits

Successful candidate will receive regionally competitive salary, above average health benefits at reduced costs, company paid life insurance & long-term disability insurance, additional voluntary retirement plan with company match and no vesting schedule requirement. Dependent on working 30+ hours per week.

• Paid bereavement and jury duty leave
• 11 paid holidays per year
• Paid time off
• Paid sick leave
• Flexible Spending Program
• Professional development hours offered annually

Physical Demands and Work Environment

The work environment is characteristic of a medical clinic environment. The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. While performing the duties of this job, the employee is frequently required to sit; use hands and arms to reach. The employee is also required to stand; walk; and reach with hands and arms. The employee must occasionally lift and/or move up to 20 pounds. Specific vision abilities required by this job include close vision, distance vision, and the ability to adjust focus. The employee must also possess hearing and speech to communicate in person and over the phone. The noise level in the work environment is usually quiet.

The employee may be in contact with individuals and families in crisis who may be ill, using substances and/or not attentive to personal health and safety for themselves or their homes. The employee may experience a number of unpleasant sensory demands associated with the client’s use of alcohol and drugs, and the lack of personal care. The employee may also be exposed to bodily fluids (blood, urine) and hazardous chemicals.

WellSpace Health is committed to the principles of equal employment. We are committed to complying with all federal, state, and local laws providing equal employment opportunities, and all other employment laws and regulations. It is the intent of WellSpace Health to maintain a work environment free of harassment, discrimination, or retaliation because of age, race, religious creed, color, national origin, ancestry, physical disability, medical condition, genetic information, marital status, sex (including pregnancy, childbirth, breastfeeding and/or related medical conditions), gender, gender identity, gender expression, sexual orientation, military or veteran status, or any other status protected by federal, state or local laws. WellSpace Health is dedicated to the fulfillment of this policy in regard to all aspects of employment, including but not limited to recruiting, hiring, placement transfer, training, promotion, rates of pay, and other compensation, termination, and all other terms, conditions, and privileges of employment.

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

WellSpace Health is an Equal Opportunity Employer

Pay: $95,680.00 - $108,500.00 per year

Benefits:

• 401(k)
• AD&D insurance
• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Work Location: In person