Director Of Credentialing
Emerald City Recruiting
Sunrise , FL 33351
Posted 2 days ago
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The Director of Credentialingserves an integral role in the organization to support andadvance the delivery of quality healthcare services provided to our patients and business partners. The Director is responsible for achieving the highest level of performance in credentialing healthcare professionals to support onboarding for recruiting, acquisition and organic growth opportunities.This role serves a key role in mentoring the team to engage, communicate and develop relationships effectively with the internal and external business partners. The Director is responsible for coaching and supporting the team in providing customer service excellence through listening, presentation and other business skills.
- Bachelor's Degree, college or university program certificate; or two to four years related experience and/or training; or equivalent combination of education and experience.
- 4 years operations and/or payor credentialing experience preferred.
- 4 years managerial level required.
- Knowledge of credentialing standards, which includes state and federal regulations as well as hospital regulations and NCQA, CMS and Joint Commission standards.
- Demonstrates good management skills and works well in a team environment with supervisor and team. Possesses excellent communication and negotiation skills.
- Plan and direct effective day-to-day operations through maintaining appropriate staffing levels to meet targeted service levels, turnaround times, and satisfaction/quality standards. This is accomplished through the use of staffing metrics and productivity measures to analyze and project departmental work volume.
- Timely and efficiently support quality credentialing standards for healthcare professionals and optimal reimbursement through application of daily process management tools and principles for the organization.
- Develop and maintain Credentialing policies and procedures and obtain appropriate levels of approval.
- Develop innovative initiatives to enhance internal efficiencies and effectiveness and work with cross-functional teams
- Monitor and analyze operational reports to evaluate efficient workflow and serve as subject matter expert in Credentialing to cross-functional areas.
- Develop, implement and manage delegation strategy to expedite credentialing. Negotiate and participate in delegated credentialing contracting with Product Development and Risk and managed care companies. Obtain approvals to support and implement delegated credentialing with provider enrollment and provide oversight for compliance to contract terms and NCQA accreditation requirements.
- Hire, train, coach, counsel and evaluate performance of direct reports
- Plan and participate in biennial NCQA Certification surveys and audits. Ensure compliance with regulatory and NCQA and Joint Commission accreditation standards, along with credentialing and re-credentialing providers
- Plan meeting schedule, prepare Agenda and materials for Delegation Committee, Credentialing Committee and Credentialing Board. Present for review and approval in advance of scheduled meeting dates.