Director of Credentialing

Description

Core Clinical Partners stands at the forefront of Emergency and Hospital Medicine, delivering unparalleled services through a model that emphasizes patient-centric care and operational excellence. Our corporate values – Genuine, Accountable, Dynamic, Respectful, and Fun – are the pillars that uphold our commitment to revolutionize healthcare delivery.

The Director of Credentialing is responsible for leading our Hospital Credentialing and Clinician Enrollment departments. This role is crucial in ensuring that our clinicians are efficiently credentialed and enrolled with hospitals and payor, maintaining compliance with all regulatory standards. This role has a dual reporting structure through Operations and Revenue Cycle Management.

Essential Duties

• Oversee and manage the Hospital Credentialing and Provider Enrollment teams.
• Develop and implement strategies to improve departmental efficiency and effectiveness.
• Provide mentorship and professional development opportunities for team members.
• Collaborate with internal departments to streamline processes and improve communication regarding clinician and financial credentialing.
• Ensure timely and accurate credentialing and re-credentialing of all providers in compliance with the hospital bylaws.
• Maintain up-to-date knowledge of all credentialing requirements and regulations that govern hospital credentialing.
• Develop tracking of crucial credentialing items such as licensure, required continuing education, and other items required by various medical staff offices at various clients.
• Ensure timely and accurate enrollment of clinicians with government and commercial payors.
• Facilitate resolution or provider related denials to ensure appeal procedures are followed to result in proper reimbursement.
• Ensure compliance with all federal, state, and local regulations related to hospital credentialing and payor enrollment.
• Develop and maintain policies and procedures to support compliance and operational efficiency.
• Conduct regular audits to ensure the integrity of credentialing data and processes.
• Work closely with the VP of RCM and VP of Operations to align credentialing processes with organizational goals.
• Participate in cross-departmental projects and initiatives to enhance overall company performance.
• Utilize data analytics to monitor performance metrics and make informed decisions.
• Ensure integrity of Clinician Data within Salesforce. Maintains detailed clinician enrollment files in electronic format, including electronically received documents, scanning of hard copy documents and documents each state of the enrollment/re-enrollment process thoroughly.
• Provide assistance with ongoing quality initiatives related to improved data processing and workflows. Keeps current regarding any changes in managed care payor requirements for clinician enrollment and participates in ongoing training sessions.?
• Stay current on hospital credentialing regulatory changes and works towards improved timing of clinician hospital credentialing. Works to improve processes to ensure a quality experience for new clinicians.
• Perform other duties as assigned
  
  

Skills, Knowledge, Abilities

• In-depth knowledge of hospital credentialing and clinician payor enrollment processes.
• Strong leadership and team management skills.
• Ability to manage a remote workforce.
• Ability to analyze data and generate actionable insights.
• Strong problem-solving skills with a proactive approach to challenges.
• Exhibit growth mindset and team-orientated behaviors
• Utilize independent judgment on determining areas of collaboration, escalation, and autonomy?
• Collaborate with professionals internal and external to the company and across geographic locations
• Knowledgeable on credentialing requirements and workflows for providers at differing client groups
• Familiar with healthcare jargon and terminology related to credentialing
• Excellent verbal and written communication skills
• Excellent interpersonal and customer service skills
• Excellent organizational skills and attention to detail
• Navigate competing priorities and effectively work in a fast-paced environment
• Manage information flow in a timely and accurate manner
• Proficient in Microsoft Office Suite and credentialing related software
  
  

Requirements

Education:

• Bachelor’s degree in healthcare administration, Business, or a related field required.
• Master’s degree preferred.
• Certified Provider Credentialing Specialist (CPCS) or Certified Professional Medical Services Management (CPMSM) preferred.
  
  

Experience

• Minimum of 7 years of experience in clinician hospital credentialing and payor enrollment within a healthcare setting.
• At least 3 years of leadership experience managing hospital based credentialing teams and working with Medical Staff Offices.
• Experience working with institutions that have various accrediting bodies such as Joint Commission or DNV.
• Experience working collaboratively across multiple departments.
• Experience with MS Outlook, Word, and Excel