The Director of Credentialing oversees the operations of the CVO to develop, manage, and monitor processes and procedures that support the credentialing, re-credentialing, expireables, and delegated credentialing processes. Oversees all of the credentialing functions including application management and primary source verification. Ensures compliance with the appropriate accrediting and regulatory agencies. Supervises credentialing staff in the day-to-day management of the overall CVO credentialing process and database management.
Responsible for the development and management of a comprehensive provider credentialing office for all CHRISTUS Health entities
Obtains accreditation of the credentialing office and obtains delegation for the managed care credentialing of CHPH network providers
Directs the CVO credentialing process for all managed care and medical staff providers, in accordance with The Joint Commission, NCQA, URAC, and CMS accreditation standards, Federal and State Laws, and CHRISTUS Health policies.
Coordinates the management of the credentialing database and associated applications, ensuring the accuracy of data and reporting to downstream systems. Monitors data for analysis and report generation.
Coordinates the management of the application process, to ensure distribution, receipt, processing, and timely delivery to clients
Directs the management of the expireables process to ensure all provider licenses, insurance, and certifications remain current, ensuring appropriate notification prior to expiration.
Monitors and reports turnaround times for processing of applications, with focus on delivery of a high-quality product with the greatest efficiency.
Participates in development and review of CVO operating policies and procedures; develops, recommends, and/or implements changes, revisions, and enhancements as appropriate to current operating environment.
Analyzes accreditation standards and develops criteria to ensure compliance.
Prepares for and coordinates credentialing audits in compliance with accrediting agencies and managed care contracts.
Functions as the primary CVO credentials contact; develops and maintains positive working relationships across ministries.
Oversees the supervision of associates, which includes training, promotion, enforcement and auditing of internal procedures, and problem resolution; evaluates performance and makes recommendations for personnel actions; motivates associates to achieve peak productivity and performance
Performs miscellaneous job-related duties as assigned.
Requirements:
Bachelor's Degree preferred or equivalent experience
Minimum 10 years working in credentialing
Minimum 7 years in a leadership position
Certified Professional in Medical Services Management (CPMSM) and/or Certified Provider Credentialing Specialist (CPCS) required
