This individual will play a critical role in assuring the delivery of superior credentialing verification services for healthcare providers and payor credentialing.
The Candidate will work closely with both internal and external parties on all aspects of Credentialing, leading an operational team to execute deliverables.
The individual will be responsible for Credentialing activities relative to quality assurance planning, client / vendor relations, and continuous improvement of operational performance including oversight of peer review.
The individual who fills this position will need to be able to work well in a cross-functional and matrixed organization and be able to be both responsive to needs and thoughtful and directive in supporting and implementing streamlining the organization's capabilities.
• Leadership and management of Credentialing operational team and collaborating with additional Medical Staff Professional (MSP) Director(s).
• Lead coordination of primary source verification and credentialing practices in compliance with NCQA standards and state and federal regulations. Candidate goal includes 18-24 months to achieve NCQA CVO certification.
• Maintains a thorough and working knowledge of important industry standards set forth by organizations such as the NCQA, CMS, etc.
• Assist with defining standard data quality checks at appropriate stages to ensure all data meets requirements for operations, analytics and reporting.
• Assist in standardizing Credentialing Operations procedures such as documentation for departmental operating procedures.
• Identify opportunities to continuously improve the Credentialing operations and provider enrollment process.
• Establishes standards for turnaround time and monitors team performance relative those standards.
• Acts as Enterprise Credentialing Product owner in collaboration with other MSP senior leadership.
• Possess a detailed understanding of provider enrollment and credentialing operations with a minimum of 7 years' credentialing system experience.
• Strong interpersonal skills to successfully interact with internal and external audiences including staff, physician leadership, department directors and vendors.
• Proven track record in establishing strong relationships with clients and vendors.
Six years of experience in administration and/or clinical management in a healthcare care setting
Previous experience with computerized information systems (email, MS Office, hospital systems, etc) required
Bachelor's degree in business, health care or related discipline required
Masters degree in health care and/or management field preferred
Licensed Registered Nurse in the State of Washington
CPCS and/or CPMSM certification through NAMSS required
Experience in a CVO, MSO or large health care organization required
Six Sigma, Lean, or other Process Management experience (PMP equivalency) strongly desired