DEPARTMENT / Network Operations
DESCRIPTION / The Director of Credentialing is responsible for the monitoring, reporting, supervision and oversight of all credentialing related activities in the Woburn Service Center. This position reports to the AVP of Network Operations. The Director of Credentialingmust have a solid knowledge of credentialing operations and possess the ability to successfully lead a team administering all aspects of credentialing. The ability to communicate information associated credentialing and develop a motivated efficient team are the essential functions of this position.
RESPONSIBILITIES / The main responsibilities of the Director of Credentialing include:
- Lead all credentialing activities for the Woburn Service Center
- Mentor and develop a successful team performing credentialing functions.
- Develop and maintain documented workflows, policies and procedures ensuring compliant NCQA standards, state regulations and client requirements
- Develop and maintain effective quality control functions
- Communicate credentialing related activities to the Woburn Service Center management/team as appropriate
- Maintain credentialing database consisting of individual practitioners, group providers and facilities
- Facilitate initial and ongoing training of all credentialing staff.
- Facilitate resource management and oversight for department projects including NCQA and state audits.
- Creating operational workflow documents for use by Beacon and with external clients.
- Participate actively in internal and external meetings; including facilitation and management of meetings that are driven by Credentialing or Network Operations related topics
- Work with Data Analytics team and facilitate set up of recurring reports for clients.
- Develop and conduct department reporting and analysis: inventory management, capacity utilization, staff productivity, quality assurance
- Coordinate annual review of department P&P’s with presentation to Quality Improvement Committee for approval
- Work with Provider Relations team and ensure timely coordination of provider site visits as designated by clients, accrediting bodies and regulatory authorities
- Collaborate with Quality department to communicate provider sanctions to appropriate regulatory bodies as necessary
- Review regulatory and accreditation guidelines on a regular basis
- Facilitate problem resolution for issues raised by providers and Beacon staff
- Foster collaborative working relationship with internal departments.
- Monitor external regulatory bodies for provider sanction information and communicate to credentialing committee as appropriate
- Act as liaison between internal departments regarding Network Operations implementation activities
- Some Travel required
- Other Duties as assigned
QUALIFICATIONS / The successful Director of Credentialing will possess the following qualifications:
- Five or more years’ experience managing credentialing staff in a health system, MCO or with a provider group.
- Outstanding hands on leader, must be able to perform the day to day tasks needed in a successful department
- Strong Leadership skills, that must be able to translate to the development of strong leaders, team members and team
- Disciplined communicator with a professional demeanor that would well represent the Woburn Service Center and Beacon Health Options internally, to providers and to our clients.
- Self-motivated with ability to handle multiple priorities and meet aggressive timelines
- Detail-oriented with ability to work independently and adapt in a fast-changing environment
- Solid understanding of the functional activities associated with credentialing
- Strong analytical and problem-solving skills with an orientation toward demonstrating results
- Excellent organization and project management skills
- Demonstrated cross-functional project leadership experience
- Solid understanding of Microsoft Office Products
- Experience developing and maintaining policies and procedures
- Knowledge of NCQA standards
- Demonstrated knowledge of credentialing database software
EDUCATION /
- Bachelor’s degree with a Healthcare concentration, preferred
- Relevant Certification strongly desired (CPCS)
CLASSIFICATIONS / Exempt
LOCATION / Woburn, MA
SUPERVISOR
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