The National Delegation Supervisor will work closely with the National Director of Credentialing to define processes around our delegated credentialing program, execute process changes internally as well as strategic departmental and company initiatives. This role will have the ability to define internal processes according to NCQA and CMS requirements in order for TPR to achieve and maintain delegation with all payor types (Commercial, Medicare, Medicaid).

Other responsibilities include:

• Strategically negotiate and implement new delegated payor agreements.
• Maintain TPR Credentialing’s NCQA Accreditation by continually ensuring our policies align with any regulatory changes.
• Oversee all TPR Credentialing Committee activities and effectively work with the TPR Credentialing Committee Chair, Committee members and Sr. Director of Quality to ensure providers are reviewed timely and relevant information is presented.
• Effectively communicate to all levels internally and externally.
• Diagnose/resolve issues that arise, educate the team, MOMs/MODs/ Practice Managers to ensure that our patients are managed on the front end according to the contracts that are in place. Communicate high-level issues to market leadership and the National Manager or Director of Credentialing.
• Maintain extensive knowledge of all health plan contracts that are in place for the markets in which they are overseeing and will have a basic understanding on how to operationalize the contractual obligations for each.
• Elevate health plan relationships to see that new physician on-boards are added to the Tenet contracts where we hold delegation arrangements by their start date. This requires the individual to represent TPR with all relevant market payors.
• Updates and strategy related to credentialing to TPR’s Market Senior Directors, Market Operations Directors, Market Operations Managers and RCM Directors nationally.
• Collaborate with the RCM team and vendor partners to resolve credentialing hiccups and ensure the claims are paid. They are responsible for monitoring all claims on credentialing bill hold to ensure each provider is enrolled timely and all claims are released prior to the timely filing deadlines regardless of the billing platform.
• Submit monthly report requirements to the National Credentialing Manager and Director and manage adds, terms and changes on the monthly TPR roster nationally.
• Manage Credentialing Specialists, Sr. Credentialing Specialists and Project Coordinators to include compensation recommendations, annual reviews, performance improvements, disciplinary action, hiring/firing recommendations.

Qualifications:

• Bachelor’s degree in healthcare management, public health, accounting, finance, business, social or behavioral sciences preferred or equivalent experience.
• 5-7 years previous managed care or prior credentialing experience or 5+ years’ experience in healthcare is required.
• Ability to travel up to 25% required. Selected candidates will be required to pass a Motor Vehicle Record check.
• Excellent analytical abilities.
• Experience in progressive health care management with emphasis in health plan/provider contracting and physician group management/contracting.
• Knowledge of primary source verification, provider enrollment and NCQA credentialing requirements.
• Proficient working knowledge of OneApp or other credentialing system and MS Office Suite of products including but not limited to Word, Excel, Project and Power Point.
• Excellent written and oral communication skills.

Tenet Healthcare complies with federal, state, and/or local laws regarding mandatory vaccination of its workforce. If you are offered this position and must be vaccinated under any applicable law, you will be required to show proof of full vaccination or obtain an approval of a religious or medical exemption prior to your start date. If you receive an exemption from the vaccination requirement, you will be required to submit to regular testing in accordance with the law.

Employment practices will not be influenced or affected by an applicant’s or employee’s race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, sexual orientation, gender identity or expression, veteran status or any other legally protected status. Tenet will make reasonable accommodations for qualified individuals with disabilities unless doing so would result in an undue hardship.