Director of Credentialing

Sunrise, FL

Posted: 02/07/2019 Category: Other Area(s) Job Number: 24454
Overview:
  • The Director of Credentialing serves an integral role in the organization to support and advance the delivery of quality healthcare services provided to our patients and business partners.  
  • The Director is responsible for achieving the highest level of performance in credentialing healthcare professionals to support onboarding for recruiting, acquisition and organic growth opportunities. 
  • This role serves a key role in mentoring the team to engage, communicate and develop relationships effectively with the internal and external business partners.
  • The Director is responsible for coaching and supporting the team in providing customer service excellence through listening, presentation and other business skills.
Qualifications:
  • Bachelor Degree, college or university program certificate; or two to four years related experience and/or training; or equivalent combination of education and experience.
  • 4 years operations and/or payor credentialing experience preferred.
  • 4 years managerial level required.
  • Knowledge of credentialing standards, which includes state and federal regulations as well as hospital regulations and NCQA, CMS and Joint Commission standards.
  • Demonstrates good management skills and works well in a team environment with supervisor and team. 
  • Possesses excellent communication and negotiation skills.
Responsibilities:
  • Plan and direct effective day-to-day operations through maintaining appropriate staffing levels to meet targeted service levels, turnaround times, and satisfaction/quality standards. This is accomplished through the use of staffing metrics and productivity measures to analyze and project departmental work volume.
  • Timely and efficiently support quality credentialing standards for healthcare professionals and optimal reimbursement through application of daily process management tools and principles for the organization.
  • Develop and maintain Credentialing policies and procedures and obtain appropriate levels of approval. 
  • Develop innovative initiatives to enhance internal efficiencies and effectiveness and work with cross-functional teams
  • Monitor and analyze operational reports to evaluate efficient workflow and serve as subject matter expert in Credentialing to cross-functional areas.
  • Develop, implement and manage delegation strategy to expedite credentialing. Negotiate and participate in delegated credentialing contracting with Product Development and Risk and managed care companies. 
  • Obtain approvals to support and implement delegated credentialing with provider enrollment and provide oversight for compliance to contract terms and NCQA accreditation requirements.
  • Hire, train, coach, counsel and evaluate performance of direct reports.
  • Plan and participate in biennial NCQA Certification surveys and audits.
  • Ensure compliance with regulatory and NCQA and Joint Commission accreditation standards, along with credentialing and recredentialing providers.
  • Plan meeting schedule, prepare Agenda and materials for Delegation Committee, Credentialing Committee and Credentialing Board.
  • Present for review and approval in advance of scheduled meeting dates.
For more information on this position, please contact our office at 877-782-3334.

 

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