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