Employment Type:
Full timeShift:
Day Shift
Description:
Manages all operational aspects of the system Central Verification Office (CVO) Reappointment Team, to ensure an efficient and effective operation in compliance with various regulatory agencies (CMS, TJC, NCQA, etc.). Responsible for the direct oversight and performance management of a file processing team in the CVO.
ESSENTIAL FUNCTIONS
1. Knows, understands, incorporates, and demonstrates the Trinity Health Mission, Vision, and Values in behaviors, practices, and decisions.
2. Manages the operational aspects of the Trinity Central Verification Office including reappointment credentialing responsibilities for Trinity RHMs, other healthcare entities as appropriate, and managed care organizations. Monitors the department budget, controls staffing levels for appropriate operation, identifies reduction of duplication work effort, and ensures operation within budget. Creates and reviews periodic and special reports to ensure conformance with departmental goals and regulatory requirements.
3. Assists with establishing staffing plan and manages human resources necessary to ensure an efficient credentialing operation (including hiring, orientation, training, performance management, and establishment of department goals). Provides appropriate in-service of credentialing standards, evaluates procedures, and facilitates continuing educational opportunities for staff. Plans office staff activities and work projects; supervises personnel to carry out and complete specific projects and duties.
4. Manages the activities required to maintain a quality provider network through appropriate activities as specified in the policy and procedure manual and delegated credentialing agreements regarding initial credentialing and re-credentialing.
5. Develops and implements process changes to improve the credentialing function.
6. Oversees the maintenance of the database to ensure a reliable source of practitioner physician information and privileges.
7. Implements policies and procedures to ensure deliverable services to various key users (RHMs, CINs, ACOs, and MCOs with delegated credentialing agreements).
8. Develops and maintains positive working relationships with customers.
9. Develops and implements processes or reviews and revises current credentialing policies and procedures to ensure compliance with Trinity and MCO quality management requirements (TJC, NCQA, NPDB, etc.). Establishes implementation strategies for centralized credentialing processes.
10. Facilitates maintenance of present facilities, office equipment, contracted services, etc. Assumes responsibility for performance of job duties in the safest possible manner, to ensure personal safety and that of coworkers, and to report all preventable hazards and unsafe practices immediately to management.
11. Establishes and maintains an appropriate customer satisfaction standard; encourages constructive and cooperative conflict resolution; promotes positive customer relationships. Promotes and leads collaborative relationships with hospital department administrative staffs, MCO support staff, and internal department staff for a smooth and effective credentialing operation.
12. Participates in professional development programs to ensure continued professional growth in the health care industry and maintains professional affiliations to keep abreast of trends, changes, regulations, and legislation in health care environment.
13. Maintains good rapport and cooperative relationships. Approaches conflict in a constructive manner. Helps to identify problems, offer solutions, and participate in their resolution.
14. Maintains the confidentiality of information acquired pertaining to patient, physicians, employees, and visitors to Trinity Health RHMs. Discusses patient and hospital information only among appropriate personnel in appropriately private places.
15. Maintains a working knowledge of applicable Federal, State and local laws/regulations; the Trinity Health Integrity and Compliance Program and Code of Conduct; as well as other policies and procedures in order to ensure adherence in a manner that reflects honest, ethical and professional behavior.
MINIMUM QUALIFICATIONS:
1. Must possess a comprehensive knowledge of credentialing and privileging, as normally obtained through a Bachelors' degree or equivalent combination of education, training, and/or experience in health care administration or a related field.
2. Five (5) to seven (7) years of health care experience with an understanding of the current health care environment, including familiarity with managed care concepts and integrated delivery systems.
3. Current CPCS and/or CPMSM eligibility by the National Association Medical Staff Services.
Certification required within one year of hire.
4. Strong communication skills including the ability to correspond effectively, as well as verbally convey information clearly, listen actively, and consider varying viewpoints when making decisions.
5. Strong statistical, analytical and problem-solving skills.
6. Ability and desire to provide quality service to others.
7. Ability to prioritize and coordinate completion of a number of activities/projects simultaneously.
8. Strong organizational skills and the ability to provide attention to detail and thoroughness.
9. Ability to work independently, prioritize and handle multiple responsibilities. A prudent self-starter, with motivation to produce high-quality output.
10. Ability to work autonomously and within a team environment.
11. Must be comfortable operating in a collaborative, shared leadership environment.
12. Must possess a personal presence that is characterized by a sense of honesty, integrity, and caring with the ability to inspire and motivate others to promote the philosophy, mission, vision, goals, and values of Trinity Health.
ADDITIONAL QUALIFICATIONS:
1. Prior management/leadership experience within a healthcare environment, preferred.
2. Maniacal attention to detail, preferred.
3. Experience with MD Staff a plus.
PHYSICAL AND MENTAL REQUIREMENTS AND WORKING CONDITIONS:
1. Must be able to travel to the various Trinity Health sites as needed.
2. Ability to complete work during high-pressure periods while maintaining flexibility and a pleasant attitude.
The above statements are intended to describe the general nature and level of work being performed by persons assigned to this classification. They are not to be construed as an exhaustive list of duties so assigned.
