Supervisor, Provider Maintenance

The Supervisor, Provider Maintenance is responsible for the direct day to day supervision and coordination of activities of their program/department with a focus on the administrative and operational duties which may include training new staff members.

• Performs Credentialing and Appeals and coordinates the full spectrum of the credentialing process for Johns Hopkins Health Plans in accordance with established policies and procedures and accreditation and regulatory requirements
• Assists in the performance of Provider Maintenance administrative and operational duties which include Coordinator education, Database Development, and Maintenance (maintaining provider demographic information in all required databases for but not limited to claims payment, member and provider directories), participates and leads various department projects, meetings and task force operations
• Supervises and coordinates the activities of staff members engaged in examining medical/dental claims for payment.
• Maintains IDX, DEERS, and IFMC database

Requirements:

• Requires a professional level of business administration and/or management generally obtained in the first two years of college or equivalent work-related experience. Bachelor’s degree preferred
• A comprehensive and expert understanding of medical/dental claims administration as acquired during 4 years of related experience. A minimum of 1 year of supervisory experience is required. Requires knowledge of ICD-9 and CPT coding
• Expert understanding of Health Insurance, Medicaid, Medicare, Enrollment processes and State regulations, COB, newborn enrollment, as acquired during three to five years of experience in managed care or insurance industry
• CPMSM or CPCS preferred

Salary Range: Minimum 25.29/hour - Maximum 44.28/hour. Compensation will be commensurate with equity and experience for roles of similar scope and responsibility. In cases where the range is displayed as a $0 amount, salary discussions will occur during candidate screening calls, before any subsequent compensation discussion is held between the candidate and any hiring authority.

The Hospital reserves the right to modify employee schedules as needed.

We are committed to creating a welcoming and inclusive environment, where we embrace and celebrate our differences, where all employees feel valued, contribute to our mission of serving the community, and engage in equitable healthcare delivery and workforce practices.

Johns Hopkins Health System and its affiliates are drug-free workplace employers.