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System Director, Credentialing

Company: National Medical Association
Location: Irving
Posted on: November 27, 2022

Job Description:

The System Director, Credentialing 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 CHRISTUS Health, for meeting and maintaining needed accreditation standards including NCQA, The Joint Commission and URAC as required by contractual and regulatory requirements.Lastly, this position will also be accountable to start and manage a Credentialing Verification Organization ("CVO") for CHRISTUS Health, allowing delegated arrangements to be put into place on behalf of employed physicians, CIN, ACO, PHO, and all networks for CHRISTUS Health.Education:

  • Bachelor's Degree; equivalent experience may be considered in lieu of Bachelor's Degree.Experience:
    • Minimum 10 years of experience in credentialing and payer roster management.
    • Extensive knowledge and experience in hospital medical staff and managed care credentialing, including delegate credentialing.
    • Minimum 5 years of experience in management / direct supervision of staff.Skills:
      • Computer skills including significant knowledge of Word, Excel, and PowerPoint
      • Working knowledge of industry requirements for NCQA, URAC, and The Joint Commission.Licenses, Registrations or Certifications:
        • CPCS - NAMSS (Certified Provider Credentialing Specialist from National Association of Medical Staff Services), preferred CPMSM - NAMMS (Certified Professional Services Management from the National Association of Medical Staff Services), preferred.Major Responsibilities:Physician, Clinician and Provider Credentialing:
          • Responsible for the development and management of a comprehensive provider credentialing office for all CHRISTUS Health entities. Obtains accreditation on behalf of the credentialing office and obtains delegation for the managed care credentialing network providers
          • Assists senior leaders in the development of provider credentialing policies for all CHRISTUS Health entities
          • Develops and executes all credentialing procedures and processes
          • Develops and maintains a collaborative relationship with all CHRISTUS Health entities. Negotiates credentialing services standards with all entities. Meets or exceeds all credentialing services standards
          • Establishes and executes a comprehensive credentialing verification office for all CHRISTUS Health entities
          • Negotiates and develops credentialing office budgets with CHRISTUS Health entities and carries out billing and collection processes
          • Develops standards for a single, system-wide, credentialing software application and ensures those standards are fully met in a manner that is consistent with all accreditation, regulatory and legal standards
          • Obtains and maintains appropriate credentialing standards and requirements for the CIN and ACO organizations
          • Obtains delegation approval, when requested, for managed care credentialing as required by the provider contracts
          • Maintains a high level of customer service standards to all CHRISTUS Health entities. Acts as a resource to members of the facility Medical Staff offices in reference to guidelines for credentialing standards and optimizing the credentialing software applications. CHRISTUS HEALTH is an international Catholic, faith-based, not-for-profit health system comprised of almost more than 600 services and facilities, including more than 60 hospitals and long-term care facilities, 350 clinics and outpatient centers, and dozens of other health ministries and ventures. CHRISTUS operates in 6 U.S. states, Colombia, Chile and 6 states in Mexico. To support our health care ministry, CHRISTUS Health employs approximately 45,000 Associates and has more than 15,000 physicians on medical staffs who provide care and support for patients. CHRISTUS Health is listed among the top ten largest Catholic health systems in the United States.

Keywords: National Medical Association, Irving , System Director, Credentialing, Executive , Irving, Texas

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