This position oversees the operations and success of multiple credentialing and enrollment departments responsible for maintaining provider credentials, privileges and provider enrollment with various hospitals, surgery centers and manager care and government payers at a regional level.
- At a regional level, supervises direct and indirect staff members with performance and talent management. Leads credentialing managers with coaching and feedback of employee work performance, work behaviors to develop skills and monitor team workflows.
- Collaborate with leadership to create credentialing standards and procedures and execute the implementation and monitoring of standards and procedures within assigned region.
- Monitor credentialing departments for possible clinical and financial risks as it pertains to provider credentialing and enrollment.
- Administers teams to be accountable for quality and production standards and monitors progress with established goals and metrics.
- Oversees the onboarding of new groups and facilities.
- Works with leadership teams to ensure compliance with (NCQA and CMS standards and guidelines; identifies and monitors The Joint Commission, URAC, AAAHC accreditation standards, and policies, and other federal and state legislation, as appropriate)
- Partners with organizational key stakeholders to support and prepare for regulatory, NCQA, CMS, and client health plan audits.
- Drives strategic relationships with contracted health plans and provider relations representatives in the oversight of the credentialing and enrollment processes of providers.
- Responsible for the quarterly distribution and reconciliation of provider rosters to contracted payers.
- Establish and foster strong working relationships with billing departments to improve processes and communication between the enrollment and billing departments.
- Maintain department budgets at or below the yearly projections.
- Models collegial environment, which fosters teamwork for local teams, with other members of the clinical services, operations and field providers.
- Provides regular reports and updates to RCM and national leadership.
- Work with local leadership to plan and prepare for future growth and needs of local offices.
- Bachelor’s degree preferred
- Five to seven years of management experience in the healthcare industry required, particularly in Anesthesia.
- Knowledge of hospital credentialing
- Knowledge of provider enrollment with commercial and government payers.
- Knowledge of Windows, Power Point, Word and Excel or similar programs required