12/25/2023 0 Comments Solis health plans reviews![]() ![]() Assists the Compliance Officer and QI Director in preparation for CMS audits.Provides supervisory support and trains Credentialing staff.Reviews and develops Credentialing policies and procedures.Develops agenda, meeting minutes and other materials for the Credentialing Committee.Ensures all State and Federal requirements are met.Participates in weekly Provider Network meetings.Participates in the internal monitoring of Chapter 11 of the Managed Care Manual.Effectively improved operational processes to achieve maximum efficiency.Reviews overtime report and ensures communication with staff as appropriate.Establishes production and error metrics for credentialing coordinator and conducts weekly reviews.Conducts file reviews on a regular basis to identify errors and counsels' staff.Monitors Credentialing reappointment and/or audit activity and ensure provider credentialing is conducted in accordance with organizational policies and applicable government and regulatory agency standards and guidelines.Responsible for timely and accurate reviews and oversight and follow-up.Prepares reports for HEDIS, Credentialing Committee and the Compliance Department.Reviews and approves communications with delegates to ensure communications are accurate and professional.Improves communications and processes between credentialing, provider relations and member services.Responsible for leading all credentialing and re-credentialing activities of health care providers and facilities to ensure compliance with appropriate accrediting and regulatory agencies. Solis is operating as a hybrid work model, meeting in-office twice a week. We believe in a culture that collaborates and supports one another, and where success is interlinked and each employee is valued. Our team consists of expert individuals that take pride in delivering quality service. Solis was born out of a desire to provide a more personal experience throughout all levels of the healthcare journey. We provide solutions that are more transparent, connected and effective for both our members and providers. Solis Health Plans is a new kind of Medicare Advantage Company. ![]()
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