About this role
Role Overview
- Manage the performance and development of direct reports, providing training, coaching, and conducting regular employee reviews
- Conduct regular performance evaluations, provide constructive feedback, and develop individualized development plans for team members
- Educate departments on credentialing policies, procedures, and internal policy changes as necessary
- Oversee The Joint Commission reviews and quarterly data submissions
- Audit and approve invoices from credentialing vendors for each SBU
- Review and approve background checks and licensing issues, escalating employment determinations when necessary
- Implement robust policies and procedures to ensure accurate verification and uploading of applications into the online credentialing database system
- Analyze application status trends, evaluate verification information, and identify areas of non-compliance or 'red flags'; recommend and execute appropriate corrective actions
- Manage incoming and outgoing communications, ensuring adherence to policy timelines while updating the credentialing database; provide status reports and communicate practitioner participation information to internal and external stakeholders
- Facilitate written and verbal communications with federal, state, and local agencies, hospitals, medical review boards, and malpractice carriers to obtain necessary provider and practitioner information
- Participate in preparation for internal and external audits to ensure accurate provider information and compliance with regulatory/accreditation requirements (e.g., CMS, DSHS, NCQA, JCAHO, DNV)
- Assist practitioners and clinicians with scheduling appointments and necessary medical procedures (e.g., physicals, drug screens, vaccinations)
- Stay informed about research, review, and interpretation of applicable accreditation, licensing, and regulatory requirements to ensure ongoing compliance of credentialing policies and procedures
Requirements
- Three years of experience in education or healthcare staffing credentialing
- Certified Provider Credentialing Specialist (CPCS) can substitute for experience
- Possess an overall knowledge of business functions and understanding of services, business strategy, policies and procedures, and job’s impact to the organization
- Understand, interpret, and ensure compliance with laws and regulations
- Maintain trust through honesty, adherence to principles, and personal accountability
- Obtain facts and data pertaining to an issue or question
- Make quality decisions and meet the timeliness of those decisions
- Share responsibility, authority, and accountability
- Create a motivating climate, achieve teamwork, train, and develop, measure work in progress, and take corrective action
- Engage effectively in dialogue
Benefits
- 401K with Competitive Company Matching
- FSA and HSA Plans
- Financial Planning Assistance
- Educational Assistance
- Generous PTO Policy
- Paid Parental Leave
- Twelve Annual Paid Holidays
- Active Employee Engagement Programs
- Cellphone Stipend
- Technology Stipend (for hybrid/remote positions)
- Diversity, Equity, Inclusion, and Belonging Program
- Professional Development
- Charitable Matching
- Medical, Dental, Vision, and Hearing Benefits
- Navigate Health and Wellness Programs
- Employee Assistance Program (EAP)
- Life and Disability Insurance
- Pet Insurance