Director of Credentialing Services

A5 Healthcare one of the fastest-growing Credentialing Verification Organizations in the country is seeking a Director of Credentialing Services who is motivated to learn, excited to collaborate and passionate about delivering outstanding results. This individual will have a direct impact on our firm’s mission of serving as a catalyst for those striving to achieve their highest potential. 

This role is responsible for ensuring physicians, clinicians, and other providers are credentialed, appointed and privileged with health plans, hospital medical staff’s, other patient care facilities, physician organizations and other network arrangements such as a clinical integrated network (“CIN”) and accountable care organization (“ACO”). Through numerous entry points throughout the system, this position is responsible for establishing and then leading/managing the standards, governance, process-flows, resource allocation and IT system access to the system credentialing software tool. Additionally, this position is accountable for maintaining up-to-date data for each physician, clinician, and provider in the database and online system, including data and reports used for payer roster management. This includes initial credentialing and re-credentialing as required by regulatory bodies, either every two years, three years, or other date spans as required. Demographic data is to be gathered and stored in a standardized manner, including proof of timely renewal of licenses and certifications. This position is accountable, on behalf of A5 Healthcare, for meeting and maintaining NCQA accreditation standards as required by contractual and regulatory requirements. This position will also be accountable to oversee the day-to-day activities associated with plan enrollment services, allowing delegated arrangements to be put into place on behalf of employed physicians, CIN, ACO, PHO, and all networks.

 

What You’ll Do:  

• Ensure physicians, clinicians, and other providers are credentialed, appointed, and privileged with health plans, hospital medical staff, patient care facilities, physician organizations, and network arrangements such as CIN and ACO.
• Establish and lead/manage standards, governance, process-flows, resource allocation, and IT system access to the credentialing software tool.
• Maintain up-to-date data for each physician, clinician, and provider in the database and online system, including data and reports used for payer roster management.
• Handle initial credentialing and re-credentialing as required by regulatory bodies, either every two years, three years, or other date spans as required.
• Gather and store demographic data in a standardized manner, including proof of timely renewal of licenses and certifications.
• Meet and maintain NCQA accreditation standards as required by contractual and regulatory requirements on behalf of A5 Healthcare.
• Oversee day-to-day activities associated with plan enrollment services, allowing delegated arrangements to be put into place on behalf of employed physicians, CIN, ACO, PHO, and all networks.

What We’re Looking For:   

• Extensive knowledge and experience in hospital medical staff and managed care credentialing, including delegate credentialing.
• Proven experience achieving and maintaining NCQA CR Accreditation including updating policies and procedures as well as overseeing processes and audits.
• Expert in credentialing software.
• Excellent communication skills.
• Computer skills including significant knowledge of Adobe Professional, Word, Excel, and PowerPoint.
• Working knowledge of industry requirements for NCQA, URAC, CMS, The Joint Commission and other accrediting bodies.

Your Qualifications:  

• Master’s Degree preferred; equivalent experience may be considered in lieu of Master’s Degree.
• Minimum 10 years of experience in credentialing, plan enrollment, delegation, and payer roster management.
• Minimum 5 years of experience in management / direct supervision of staff.
• CPCS – NAMSS (Certified Provider Credentialing Specialist from National Association of Medical Staff Services).
• CPMSM – NAMSS (Certified Professional Medical Services Management from the National Association of Medical Staff Services).

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