Team Leader Operations -Provider Credentialing and Contracting

Company Description

Why Wellmark : We are a mutual insurance company owned by our policy holders across Iowa and South Dakota, and we’ve built our reputation on 85 years’ worth of trust.

We are not motivated by profits. We are motivated by the well-being of our friends, family, and neighbors our members. If you’re passionate about joining an organization working hard to put its members first, to provide best-in-class service, and one that is committed to sustainability and innovation, consider applying today!

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Why Leadership at Wellmark :

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Job Description

In this leadership position you will oversee staff and functions that support Wellmark's provider credentialing and provider data management.

Provide leadership for a team of Credentialing & Contracting Specialists, with a goal of provider data accuracy and a positive provider experience.

Manage business processes within the department to optimize the performance of Wellmark's credentialing against aging goals and regulatory criteria.

Promote teamwork and strong collaborative relationships across the organization as well as external health care providers and vendors.

Qualifications

Required :

• Bachelor's degree or direct and applicable work experience
• 4+ years of proven effective leadership in a medium to high complexity organization including leadership skills typically gained through a combination of project or informal leadership that demonstrates knowledge of work processes, services, or leadership competencies
• Ability to effectively coach and mentor others and lead teams through change and performance improvement
• Demonstrated ability to effectively organize and guide teams of people in the achievement of goals, objectives, and desired results, while demonstrating commitment to recognition of / development of individual team members
• Demonstrated ability to communicate effectively and professionally, verbally and in writing, expressing complex concepts clearly and concisely to various levels of audiences
• Process management knowledge, as well as experience leading multi-division projects
• Travel required up to 5%

Additional Information

a. Provide leadership and day-to-day management of financial and human resources, primarily focusing on employee coaching, development, performance improvement, coordination, and budgeting for the team's specific functions / services.

Support training and development of team for continuous improvement concepts and readiness for new systems and processes.

Support business objectives and produce results that are effective, accurate, timely, and on target to meet business and stakeholder needs.

b. Lead team and oversee activities such as policies, procedures, knowledge management, and program manuals that support credentialing and provider data management functions.

Represent the department and corporation on topics pertaining to Wellmark's provider credentialing to external audiences including health care providers, health systems, national health care organizations, Blue Cross Blue Shield Association, third party vendors, and other stakeholders.

c. Lead activities that support the maintenance and analysis of Wellmark's provider credentialing and network status data housed in department database and Wellmark's systems.

Outcomes may include supporting provider data management, data extracts and report generations, with a focus on production, for the Credentialing and contracting team.

Identify trends and make recommendations regarding production efficiencies and effectiveness. Develop and implement plans once identified.

d. Lead and participate in key department / division and interdepartmental / interdivisional projects through the effective use of process management tools and programs.

e. Sustain effective production levels for the team / department through effective staff motivation, workload distribution and management to meet stakeholder requirements including cycle times and accuracy defect levels.

f. Meet or exceed reporting standards for department activities and compare all results against performance standards, and state and national standards.

Continually seek new sources for validation of "best in class" processes and participate in BCBSA or other surveys that compare this information.

g. Maintain successful NCQA accreditation in accordance with all requirements and work collaboratively with Wellmark leaders and quality staff.

Maintain results to support successful results in any BCBSA mandated audit programs. If corrective actions are needed, work collaboratively across the department for improvements.

h. Understand Wellmark and other payers' provider credentialing and manage / maintain this information in department databases and other systems to support accurate reporting and claims processing.

i. Drive problem solving and continuous process improvement strategies. Assume overall responsibility and ensure that processes, policies and procedures meet compliance requirements and result in meeting company goals, operational efficiencies, cost saving and customer satisfaction and retention.

Direct, develop and support process improvements, delegating to and coordinating with leadership team as appropriate.

j. Other duties as assigned.