Accountable for the delivery of management & consulting services which provide support to the Medical Group, Region, CSA's, medical centers, & medical offices for credentialing issues. Accountable for systems & quality improvement processes that ensure compliance w/ Regional Credentials policies & procedures, program, regulatory, & accrediting agencies credentials requirements.
Essential Functions:
- Manages the design, development, coordination, & quality of the credentialing process
- Creates operations & communications processes that support organizational strategies & business objectives
- Provides consulting services regarding regulatory, legal, accreditation program, & Regional credentialing standards throughout the region
- Manages the credential budget
- Manages credentialing function for TPMG Human Resources Department
- May coach, train, & direct work of credentialing staff
- Creates & manages credentials budget
- Works w/ practice site Credentials & Privileges Coordinators to share & implement best practices whenever feasible
- Interprets requirements & disseminates information to all involved parties to assure necessary compliance, compatibility, & continuous quality improvement of credentialing processes
- Informs Medical Group & KFH/P leadership of key issues & acts as Medical Group agent in influencing changes in program & agency requirements
- Partners w/ appropriate Program, Regional, CSA, Medical Group individuals & groups, accrediting bodies, & external consultants to develop & implement systems & processes that meet requirements & adhere to Regional Credentialing policies & procedures
- Collaborates w/ interregional peers to identify & implement best practices
Qualifications:
Basic Qualifications:
- Significant experience (usually 5+ years) in health care in an administrative or managerial position related to credentialing &/or accreditation
- Bachelor's degree in Health Care Administration, Public Health, or related field, or equivalent experience required
- Master's Degree preferred
- Certification as Certified Provider Credentialing Specialist (CPCS) preferred
- Extensive knowledge of the credentialing process, accreditation, & regulatory standards
- Significant knowledge of Federal & State regulatory requirements & accreditation standards e.g., The Joint Commission, TITLE 22, NCQA, NPDB, & certifying agencies
- Strong organization & communication skills & attention to details required
- Demonstrated problem-solving skills & initiative
- Proficient w/ Medical Terminology
- Ability to lead & facilitate processes through influence & collaboration
- Must be able to work in a Labor/Management Partnership environment
External hires must pass a background check/drug screen.
We are proud to be an equal opportunity/affirmative action employer.