North American Partners in Anesthesia

Director of Credentialing Operations

US-NY-Melville
4 weeks ago
Req ID
2017-2510
# of Openings
1
Category
Contracting and Credentialing

Overview

Leads and directs all credentialing and re-credentialing operations internally and externally with managed care organizations, hospitals, and office based suites in accordance with nationally recognized guidelines including NCQA, JCAHO, and CMS.  Drive revenue optimization by working closely with senior leaders to ensure providers are credentialed appropriately and timely. Deliver exceptional customer service and support in a high energy, growing work environment.

The Location

Melville, NY

Position Requirements

ESSENTIAL DUTIES AND RESPONSIBILITIES:

  • Initiate process improvements and establish priorities for the credentialing staff.
  • Oversees all areas of credentialing including commercial and government payor enrollment activities, obtaining and monitoring medical staff privileges, primary source verification activities and expirables management. Development and revise as needed all training materials, policy and procedures, and work flow processes in the department.
  • Forster a customer friendly focused team environment.
  • Monitor quality and performance of the department through auditing, reporting, and reeducation activities on an ongoing basis.
  • Trouble shoot, problem solve, and process improve all areas of Credentialing.
  • Effectively Interpret and communicate credentialing issues, guidelines, and requirements with internal staff and departments as well as outside agencies.
  • Maintain compliance and stay knowledgeable of standards and requirements as it pertains to credentialing, including the National Practitioner Data Bank (NPDB), hospital by-laws, and other agencies.
  • Supports management to ensure company goals, as it relates to credentialing, are carried out accurately and efficiently.

 

 

QUALIFICATION / REQUIREMENTS:

  • Demonstrated leadership experience with a proven successful history of directing a winning team.
  • Prior progressive responsibility and experience in medical staff services managed care credentialing, revenue cycle management or related area preferred.
  • Excellent organizational, problem solving, and communication skills.
  • Thorough knowledge of credentialing standards, laws, and regulations with NCQA, JCAHO, CMS, and other regulatory bodies a plus.
  • Experience in policy development and implementation.
  • Highly self-motivated with a strong work ethic and ability to motivate.

 

EDUCATION and/or EXPERIENCE:

  • Bachelor's or higher level Degree preferred.
  • Certification by the National Association of Medical Staff Services (NAMSS) as a Certified Provider Credentialing Specialist (CPCS) or Certified Professional Medical Services Management (CPMSM) Certification a plus.

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