PRIMARY FUNCTION: The Director of credentialing is responsible for all aspects of licensure and credentialing processes for the clinicians. Develops and implements policies and protocols related to clinicians and PA’s credentialing verifications to ensure the company is in compliance and industry standards and best practices are applied. Ensures corporate growth initiatives are supported with regards to credentialing and privileging. This individual and team play a key role in linking operations and systems to ensure credentialing functions are in sync with corporate growth initiatives.
REPORTS TO: Vice President of Analytics-Value Based Care
SUPERVISORY RESPONSIBILTIES: Supervises other employees to include evaluating and completing annual evaluations. Instructs other employees in methods or procedures needed to carry out their job as well as makes work assignments. Responsible for overseeing all aspects of staffing for the credentialing department to include hiring, training, directing, and coaching.
ESSENTIAL FUNCTIONS OF THE JOB: (This list may not include all of the duties that may be assigned.)
1. Credentialing and privileging
* Develops and maintains credentialing/privileging policies and procedures in compliance with industry standards and best practices, local, state, and federal laws and regulatory requirements. Coordinates and participates in quality improvement activities to ensure compliance and continuous enhancements of Credential/Privileging processes.
* Oversees and maintains the data integrity and functionality of credentialing database; generates reports and prepares audits as requested.
* Function as primary contact for all internal and external inquiries regarding Credentialing and Privileging, and potential and/or existing practitioners regarding credentialing.
* Oversees and ensures that all necessary licenses and credentials are verified and updated for the respective healthcare facility. This might include conducting background checks through finger printing, contacting licensing boards, reviewing license applications, obtaining education information and interviewing references.
* Develop strategic processes to improve and achieve optimal efficiency in accurate/completeness file processing
2. Strategic Planning
* Advises leadership on changing regulatory requirements and implications for the company's business model and strategic goals.
* Responsible for providing oversight and management of department budgeting and forecasting, goals, and initiatives.
* Develop and maintain KPI and reports to ensure optimal performance and responsiveness to internal and external stakeholders
3. Department Management
* Hire, develop, coach, appraise, reward and retain a highly qualified credentialing department staff; motivate and mentor credentialing staff; lead by example through appropriate participation and involvement in and oversight of credentialing activities.
* Plan, provide continuity, and lead succession planning efforts for all credentialing positions.
* Leads, manages, and ensures optimal training and mentoring for the credentialing team.
* Monitors and evaluates the performance of staff; gives timely feedback; and manages all aspects of staffing to include hiring, training, rewarding, disciplining, and terminating staff.
Adhere to all organizational information security policies and protect all sensitive information including but not limited to ePHI and PHI in accordance with organizational policy, Federal, State, and local regulations.
TYPICAL WORKING CONDITIONS:
Lift/Carry 20 lbs. or less
Other Physical Requirements
Sense of Touch
EDUCATION: Bachelor’s degree required or 10 years of experience to commensurate education.
Certified Professional Medical Services Management (CPMSM) or Certified Provider Credentialing Specialist (CPCS) certification, preferred
EXPERIENCE: Minimum 5 years of credentialing and management experience required. Previous healthcare required.
KNOWLEDGE, SKILLS & ABILITIES:
* Attention to detail and ability to manage multiple deadlines coupled with the ability to think and act strategically.
* Ability to ensure integrity of information and workflow processes.
* Ability to inspire trust and teamwork and motivate staff to work diligently and collaboratively.
* Effective at establishing and cultivating strong relationships to work collaboratively with others to achieve common goals and objectives.
* Strong organizational skills that reflect ability to perform and prioritize multiple tasks seamlessly with excellent attention to detail.
* Expert level written and verbal communication skills.
* Demonstrated proactive approaches to problem-solving with strong decision-making capability.
* Demonstrated ability to work well with people from a wide diversity of demographic and cultural characteristics; must be capable of achieving results while maintaining an inclusive, collaborative leadership style.
* Forward looking thinker, who actively seeks opportunities and proposes solutions.
* Technology savvy for web-based instructional techniques and tools.
* Computer proficiency, including MS Word, Excel, Outlook, PowerPoint, Internet tools.
* Follows HIPAA, compliance, privacy, safety and confidentiality standards at all times.
* Promotes excellent public relations and customer service to internal and external customers.
* Adapts and is willing to learn new tasks, methods, and systems.
* Consistently adheres to the time management policies and procedures.
* Proven ability to work in a fast-paced, highly dynamic environment.