At Houston Methodist, the Supervisor Payor Credentialing (SPC) position is responsible for the daily staff supervision and operations for Houston Methodist Primary Care Group and Specialty Physician group's payor credentialing team. The Supervisor Payor Credentialing is responsible for the verification and assessment of a healthcare providers qualifications to join a network to become eligible for reimbursement from commercial and government health plans. The SPC proactively interacts with providers, enrollment staff, med-staff services, insurance plans, HR recruitment, clinical departments and leadership to facilitate provider enrollment, and to maximize reimbursement for services rendered.

The supervisor position responsibilities include overseeing the daily work activities of the work unit/department staff, ensuring quality, productivity, functional excellence and efficiency. This position trains and supervises staff while maintaining adequate staffing levels and budget compliance. The supervisor position contributes to staffing decisions such as hiring, coaching and counseling employees on work related performance. This position assists in the development and implementation of policies and procedures to ensure a safe and effective work environment. Other duties for the supervisor position include participating in performance improvement activities, as well as providing support for department management to achieve operational goals. This position may also perform staff duties and responsibilities as needed.

PATIENT AGE GROUP(S) AND POPULATION(S) SERVED
Refer to departmental "Scope of Service" and "Provision of Care" plans, as applicable, for description of primary age groups and populations served by this job for the respective HM entity.

HOUSTON METHODIST EXPERIENCE EXPECTATIONS

• Provide personalized care and service by consistently demonstrating our I CARE values:
  • INTEGRITY: We are honest and ethical in all we say and do.
  • COMPASSION: We embrace the whole person including emotional, ethical, physical, and spiritual needs.
  • ACCOUNTABILITY: We hold ourselves accountable for all our actions.
  • RESPECT: We treat every individual as a person of worth, dignity, and value.
  • EXCELLENCE: We strive to be the best at what we do and a model for others to emulate.

• Practices the Caring and Serving Model

• Delivers personalized service using HM Service Standards

• Provides for exceptional patient/customer experiences by following our Standards of Practice of always using Positive Language (AIDET, Managing Up, Key Words)

• Intentionally collaborates with other healthcare professionals involved in patients/customers or employees' experiential journeys to ensure strong communication, ease of access to information, and a seamless experience

• Involves patients (customers) in shift/handoff reports by enabling their participation in their plan of care as applicable to the given job

• Actively supports the organization's vision, fulfills the mission and abides by the I CARE values

PEOPLE ESSENTIAL FUNCTIONS

• Participates in management responsibilities of selection, scheduling, supervision, retention, and evaluation of employees in the department. Provides development and mentoring of staff. Ensures that all department staff are properly trained and comply with all policies and procedures. Assists with meeting or exceeding threshold goal for department turnover.

• Consults with department leadership on coaching/corrective counseling and staff performance to achieve desired outcomes. Conducts new hire feedback sessions and provides recognition/commendations, as appropriate.

• Creates and maintains an environment of collaboration by role modeling teamwork within the department. Effectively interacts within and between departments ensuring seamless flow of information/communication. Role models clear and professional communication to facilitate problem resolution to achieve mutual understanding. Teaches others to critically think by verbally expressing rationale for decisions and follows up consistently.

• Meets or exceeds threshold goal for department and/or system metrics on employee engagement indicators.

• Provides oversight to credentialing team members and ensures all required credentialing documents are given to providers (MD/APP/PhD/SW), and operational leaders (both internally and externally) in a timely manner

SERVICE ESSENTIAL FUNCTIONS

• Oversees daily department operations, schedule and activities. Sets priorities and functional standards, giving direction to staff as necessary to ensure the best possible delivery of service and high customer/patient satisfaction.

• Organizes the workflow, proactively problem solves, anticipates needs, and manages multiple ongoing priorities. Provides reports to management of needs, issues to be addressed, and all important information necessary to ensure department success. Serves and actively participates on various committees as directed.

• Ensures the credentialing team prepares all commercial, Medicare and/or third-party application forms required for credentialing and enrollment purposes for new providers; run reports and manage existing provider accounts for re-credentialing, re-validation and working expirable.

• Provides regular and ad-hoc reporting regarding credentialing status.

QUALITY/SAFETY ESSENTIAL FUNCTIONS

• Ensures a safe and effective working environment; assists in monitoring and/or revising the department safety plan and/or any specific accreditation/regulatory agency required safety guidelines.

• Uses and optimizes information systems to enhance operations; participates in performance improvement and data management/analysis functions as directed.

• Employs a proactive approach in the optimization of positive outcomes by monitoring and improving the department workflow, supporting peer-to-peer accountability, and identifying solutions via collaboration. Role models situational awareness, using teachable moments to improve safety. Participates in investigations as a result of the root cause analysis process as assigned by manager.

• Monitors self and ensures employee compliance with policies, procedures, and System HR Standards of Practice and performs associated actions upon non-compliance (i.e., focal point review requirements, disaster plan, inservices, influenza immunization, wage and hour, standard hours, timely termination submission, timely timecard approval, etc.).

• Ensures all physician, APP and therapist credentialing information is validated, accurate and in compliance with government and organizational standards and requirements.

• Responsible for maintaining knowledge of current health plans and regulatory requirements for enrolling providers, work with extremely confidential and sensitive information.

FINANCE ESSENTIAL FUNCTIONS

• Assists in the management of essential and non-essential department expenditures to achieve financial target through optimization of productivity, supply/resource efficiency, minimizing incidental overtime and overtime percentage, and other areas according to department specifications.

• Manages staffing needs including scheduling, time off requests and time keeping.

• Ensure timely submission of all credentialing paperwork to managed care plans allowing physicians, APP's and therapists to commence in patient care upon start date.

• Monitors credentialing denials needing to be worked and trending of payor credentialing denials. Resolves denials and implements processes improvement changes to prevent future errors.

GROWTH/INNOVATION ESSENTIAL FUNCTIONS

• Implements change, demonstrating the ability to motivate employees and follow through to ensure change in behavior has actually occurred. Supports Houston Methodist and department goals and vision. Identifies industry trends and implements innovative solutions for practice or workflow changes to improve department operations.

• Develops skills of team members and continually assists with improving competencies, performance and outcomes. Fosters a positive and constructive teaching environment by engaging staff/team members in learning opportunities that are valuable and in alignment with business objectives. Conducts conversations with staff on their development and My Development Plan (MDP).

• Seeks opportunities to identify self developmental needs and takes appropriate action. Ensures own career discussions occur with appropriate management. Completes and updates MDP on an on-going basis.

• Management of all credentialing relates databases/systems on a continual basis looking for opportunities to improve reporting and tracking capabilities. Proactively audits payor directories for current and accurate provider information

This job description is not intended to be all-inclusive; the employee will also perform other reasonably related business/job duties as assigned. Houston Methodist reserves the right to revise job duties and responsibilities as the need arises.

EDUCATION

• Associate degree or additional two years of experience (in addition to the minimum experience requirements listed below) in lieu of degree.
  

• Bachelor's degree preferred
  

WORK EXPERIENCE

• Five years of payor credentialing or other applicable experience
  

• One year of lead role responsibilities preferred
  

LICENSES AND CERTIFICATIONS - REQUIRED

• N/A

LICENSES AND CERTIFICATIONS - PREFERRED

• CPCS - Certified Provider Credentialing Specialist (NAMSS)

KNOWLEDGE, SKILLS, AND ABILITIES

• Demonstrates the skills and competencies necessary to safely perform the assigned job, determined through on-going skills, competency assessments, and performance evaluations

• Sufficient proficiency in speaking, reading, and writing the English language necessary to perform the essential functions of this job, especially with regard to activities impacting patient or employee safety or security

• Ability to effectively communicate through a variety of channels with patients, physicians, family members and co-workers in a manner consistent with a customer service focus and application of positive language principles; engages the recipient(s) and helps them understand and retain the message

• Demonstrates the ability to interact with others in a way that gives them confidence in one's intentions and those of the organization

• Demonstrates leadership qualities and critical thinking through self-direction initiative, effective interpersonal skills, and oral/written communication skills

• Ability to identify and understand issues, problems and opportunities; and recommend solutions

• Ability to work effectively in a fast paced environment

• Demonstrates flexibility and adaptability in the workplace

• Knowledge of governmental and commercial payer credentialing requirements.

SUPPLEMENTAL REQUIREMENTS

WORK ATTIRE

• Uniform No
• Scrubs No
• Business professional Yes
• Other (department approved) Yes

ON-CALL*
*Note that employees may be required to be on-call during emergencies (ie. DIsaster, Severe Weather Events, etc) regardless of selection below.

• On Call* No

TRAVEL**
**Travel specifications may vary by department**

• May require travel within the Houston Metropolitan area Yes
• May require travel outside Houston Metropolitan area No

Houston Methodist Specialty Physician Group - As one of the nation’s leading hospitals and academic medical centers Houston Methodist has brought together some of the nation’s leading experts in multiple specialties to serve our patients.  As part of Houston Methodist Specialty Physician Group (HMSPG), these specialists not only provide excellent clinical care, but are on the forefront of research, developing leading-edge technologies and treatments, and teaching the medical pioneers of tomorrow.  This combination of clinical service, research and academics ensures patients have access to the latest in treatments and technologies while providing the best in comprehensive patient care.  Established as a non-profit corporation and certified by the Texas State Board of Medical Examiners, HMSPG enables physicians to maintain autonomy with respect to their clinical practice while growing their practice within an academic environment.