• Team Leader Credentialing Policy & Provider Systems

    Location US-IA-Des Moines
    Job ID
    Clinical/Provider Support
    Requires Non-Compete?
  • Job Summary

    About the Team: The Network Administration department is a diverse team that leads the development and implementation of policy for provider credentialing, recredentialing, and for network participation through provider agreements. In addition, the department is responsible for provider data collection, management and reporting, they lead provider data system configurations to support Wellmark's health networks and enterprise projects, they lead efforts in provider communication and education, and they support other related initiatives. Lastly, Network Administration is responsible for Accreditation and the Quality Program.


    About the Role: As Team Leader, you will help the Director Network Administration develop, implement, and maintain Wellmark’s health networks and provider credentialing policy. You’ll participate in department and division-level strategy and structural development sessions in support of related programs, policies, data accuracy, and technical system solutions. You’ll be leading a diverse, highly motivated team by fostering a collaborative environment where best practices, information sharing, and process improvement ideas are critical.


    About You: You’re passionate about leading, coaching, and developing people. Because this role is a leader of others, you’ll directly impact the success, growth, and development of team members by setting clear expectations, defining accountabilities, coaching to each team member’s unique strengths, facilitating change, and providing an overall positive and team-centric work environment. Being a role model in behaviors that demonstrate Wellmark’s core competencies and strengths-focus is a must.


    In addition to a passion for leading others, you’re effective at delivering high quality, timely results. You’re at your best when you can provide right-hand support to leadership, ensuring that projects and initiatives are moving forward, prioritizing needs based on business objectives, and communicating updates along the way. When the project list grows longer and more complex, you’re the person we turn to first—you’re like mission control to a team due to your vast knowledge of organizational strategy, interdependencies, quick critical thinking skills, and constant contingency planning.


    **This role requires a non-compete agreement.**

    Minimum Qualifications Required (all must be met to be considered)

    • 4+ years of experience leading teams assigned to initiatives or projects. Experience should reflect:
      • Demonstrated project management effectiveness. Ability to produce results with cross-program and divisional teams, such as technology or project management.
      • Tracking and reporting on multiple initiatives or projects with increasing levels of accountability and complexity. Exposure to all project phases, understanding milestones and ability to regularly deliver business results timely.
    • 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.
    • Strong written and verbal communication skills. Ability to present complex information to diverse audiences and effectively facilitate meetings.
    • Effective consulting skills, including the ability to guide and influence others. Proven success building relationships and collaborating to drive results.
    • Excellent research, critical thinking skills, and attention to detail. Knowledge of applicable policies, regulations, or guidelines and their potential implications to the department.
    • Proactive, thoughtful approach to project management with the ability to effectively manage and implement multiple, competing priorities in a fast-paced, dynamic work environment.
    • Creative, continuous improvement-focused approach. Ability to analyze information, evaluate workflows/processes, and identify and implement efficiencies.
    • Ability to travel (<5%) as needed. Valid driver’s license required.

    Hiring Specifications Preferred

    • Bachelor's Degree.
    • Related health insurance or a health care experience, including knowledge of:
      • Provider data systems and provider data.
      • Business processes where provider information is necessary for claim adjudication, benefit and domestic benefit tiering, or network build and maintenance.
    • Knowledge of IT system implementation methodologies, including SDLC and Agile.
    • Formal leadership experience.

    Job Accountabilities

    a. Provide day-to-day leadership and management of a team, primarily focusing on establishing and supporting a culture of collaboration, teamwork and performance improvement. Be a self-driven, reflective Team Leader who hires and enables the development of skilled team members to handle the variety of tasks assigned, through coaching, mentoring, development and nurturing innovative ideas.

    b. Provide strategic consultation and support to the Director for the development, implementation, and maintenance of effective health networks. Support business objectives and produce results that are effective, accurate, timely, and on target to meet business and stakeholder needs. Participate in department and division level strategy and structural development to support requirements relating to network administration programs, policies, data accuracy and technical solutions. Regularly ensure policy is reviewed, updated, and new policy developed and implemented timely.

    c. Credentialing in consultation with the Director Network Administration, will perform risk management and ongoing monitoring of provider participation in Wellmark networks. Track, monitor and execute with and without cause provider agreement terminations under the guidance of the Director Network Administration.

    d. Ensure all risk management activities conducted within Network Administration are in compliance with NCQA guidelines, the Public Exchange or other accrediting standards, compliance, Wellmark and department policy.

    e. Lead the team in a coordinated and collaborative way with internal and external stakeholders primarily the BCBSA to ensure provider data accuracy is achieved and is aligned with state and federal regulations, association requirements, and accreditation requirements. Manage and support remediations and compliance issues based on provider data.

    f. Meet or exceed reporting standards for department activities and dashboards and compare all results against national standards as applicable. Continually seek new sources for validation of best in class processes and participate in BCBSA or other surveys that compare this information. Projects Manage and oversee enterprise/division/department projects and initiatives in support of Wellmark's provider data systems, credentialing and contracting programs and policies. Apply strong planning, analytical, strategic thinking, and problem solving skills in the design and roll out of new Wellmark initiatives. Ensure consistent implementation of the pre-established process for provider inquiry escalation with representatives from Provider Service/Customer Service/Legal/Leadership.

    g. Collaborate with key internal stakeholders and external vendor partners to develop, implement and maintain network administration project/programs, settingup networks, policy and government methodologies and technical systems. Ensure all technical systems are synchronized and policies are in compliance with contractual obligations.

    h. Manage and implement projects by managing interdependencies, interrelationships, requirements and solutions of multiple projects and systems. Leverage business resources effectively by continually supporting system development life cycle (SDLC) and the facilitation/coordination of multiple project schedules from a business and system perspective to ensure timelines and mandated dates are met.

    i. Mentor process improvement endeavors within the Network Administration department to initiate and implement improvements that support department and division goals. Ensure process improvement opportunities incorporate industry & market knowledge best practices, pricing methodology, etc..

    j. Other duties as assigned.


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