Advance Health

Director of Credentialing

Job Location US-VA-Chantilly
Posted Date 1 week ago(2/12/2018 2:07 PM)
Job ID
2018-2189
Type
Regular Full-Time
# of Openings
1

Overview

The Credentialing Director is responsible for overseeing all aspects of the credentialing/re-credentialing of practitioners in accordance with NCQA. Assure compliance with CMS, Clients and regulatory entities. The Director is responsible for annual quality improvement reports. Also responsible for preparation of materials submitted to the Credentials Committee monthly meetings for review of practitioners/providers with variances. Also responsible for pre-delegated and annual audits of all credentialing delegated entities.  Train and mentor team members of the team. The Credentialing Director acts as a liaison between our company and ourProviders.. Additionally, the Credentialing Director will educate and effectively work with the credentialing team and clinicians to facilitate a seamless credentialing experience. The Credentialing Director is responsible for directing all activities related to credentialing operations and payer enrollment, and for the continued growth and development of the organization.

Responsibilities

  1. Lead, participate in, and monitor all credentialing and re-credentialing efforts
  2. Review and analyze practitioner applications to ensure eligibility
  3. Manage the end to end credentialing process
  4. Prepare credentials files for presentation to committees, payers, and clients within established deadlines or appoint designee
  5. Support Credentialing and Quality meetings on an ongoing basis; coordinating meeting times, schedules, developing agenda and presenting necessary documents for review with the respective committees
  6. Develop and maintain credentialing policies and procedures
  7. Ensure compliance with regulations and contractual obligations
  8. Set up Cactus to eventually maintain an accurate, up-to-date database of practitioners’ credentials.
  9. Maintain expertise regarding credentialing practices and seek advanced certifications
  10. Interact successfully with all internal and external customers, providing the highest level of customer service
  11. Prioritize and successfully manage multiple projects and multiple requests
  12. Work with Clinical Onboarding team to orient provider candidates and newly hired providers to onboarding and credentialing processes, and staff serve as their primary contact regarding the status of credentialing and re-credentialing applications
  13. Coordinates with Clinical Onboarding/Recruitment team to provide/obtain documentation of required credentials and provides orientation to the credentialing process for newly hired clinical support staff
  14. Develop use for “Cactus” credentialing tool; keeping all aspects of the tool current and optimal with the assistance of key stakeholders
  15. Effectively use financial information for strategic and operational decision making, participate in the preparation of annual budgets, and monitor performance to budget and meet agreed upon metrics
  16. Perform all responsibilities in a professional manner, be honest, work well with others, and maintain a positive attitude
  17. Understand how the organization operates and evaluate the impact of decisions on others, promoting teamwork across the organization
  18. Assume other duties assigned

Qualifications

  1. Associate or Bachelors’ degree, preferred
  2. Minimum of two years’ experience in payer or hospital credentialing, preferred
  3. CPCS or CPMSM certification, preferred
  4. 3 years’ experience in managing a Credentialing Department
  5. Knowledge of Credentialing standards for the National Committee for Quality Assurance (NCQA) and regulations for the Centers for Medicare and Medicaid Services (CMS)

 

 

*Advance Health is an Equal Opportunity Employer*

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