Director Provider Credentialing
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Job Location:
Santa Ana, CA - USA
Monthly Salary:
Not Disclosed
Posted on:
30+ days ago
Vacancies:
1 Vacancy
Job Summary
The Director of Provider Credentialing is responsible for coordinating the administrative function related to the credentialing and privileging process for all applicable medical staff and allied health professions. The Director is responsible for the entire physician credentialing & payor enrollment process which ensures everything is complete and up to date and meets all regulatory requirements. Ensures interpretation and compliance with the appropriate accrediting and regulatory agencies while developing and maintaining a working knowledge of the statutes and laws relating to credentialing. Responsible for the accuracy and integrity of the credentialing database system and related applications. Develops departmental plans budgets and directs staff as appropriate. This position maintains a high level of confidentiality attention to detail & professionalism.
ESSENTIAL FUNCTIONS:
To perform this job successfully an individual must be able to perform each essential function satisfactorily with or without accommodation. The requirements listed below are representative but not all inclusive of the knowledge skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential job functions.
- Provides leadership direction process improvement models and initiatives and establishes evidence-based best practice analysis to improve/establish work standards
- Responsible for leading coordinating monitoring and maintaining the accuracy and integrity of the credentialing and re-credentialing process in the California Market.
- Develop new processes and organization with the appropriate skillset to effectively and efficiently perform credentialing including provider credentialing hospital privilege credentialing and payer enrollment.
- Individual responsibility for credentialing decisions and authorizing clinician billable service.
- Experienced leadership required for multi-faced environment; role primarily focuses on tactical execution. Receives assignments in the form of objectives and determines how to use resources to meet schedules and goals.
- Provides oversight of the process by maintaining a working knowledge of requirements of Center of Medicaid/Medicare Services (CMS) National Committee for Quality Assurance ( NCQA) and 3rd party insurance requirements.
- Works with Field Management and the Acquisition Team to identify and start the credentialing process early with as much advance notice as possible as to not negatively affect the Companys billing process.
- Provide effective leadership coaching counseling evaluating and mentoring of staff in an effort to identify and implement opportunities for improvement.
- Participates in Human Resources related functions such as Interviewing Identifying Selecting and Developing talent Performance Appraisals (30 60 90 day annual) Disciplinary Actions Time Card Approvals and Salary Administration.
- Responsible for developing mentoring and guiding team members for future growth and identify resource needs with appropriate approval
- Maintains an appropriate professional appearance and demeanor in accordance with Company policies.
- Keep commitments and keep direct supervisor informed of work progress timetables and issues.
- Maintain strict compliance with State Federal and other regulations (e.g. OSHA WC HIPAA ADA FEHA DOL HR policies and practices).
- Other duties as assigned by management.
QUALIFICATION GUIDELINES: REQUIRED:
- At least 8-10 or more years of related work experience.
- Operational management knowledge of medical offices.
- Equivalent to high school diploma or general education degree (GED). Director Provider Credentialing
DESIRABLE:
- Associates or Bachelors Degree.
- Knowledge of WORD EXCEL POWERPOINT and Care Cloud applications.
- Experience leading a team mentoring and coaching subordinates.
- Experience with Credentialing of Healthcare Professionals; experience in the Ophthalmic industry.
CERTIFICATES/LICENSES/REGISTRATIONS:
Certified Credentialing Specialist (preferred
Required Experience:
Director
Key Skills
- Fundraising
- Management Experience
- Coaching
- Analysis Skills
- Strategic Planning
- Team Management
- Budgeting
- Leadership Experience
- Mentoring
- Public Speaking
- negotiation
- Supervising Experience
About Company
Our industry-leading team of doctors and staff are committed to providing best-in-class eye care services and comprehensive treatment to the people in our communities.
