Providence, Rhode Island, Rhode Island
United States - Nationwide
Oklahoma
Bethlehem, Georgia
Concord, NC
Posted: 09-Sep-24
Location: Irving, Texas
Salary: Open
Categories:
Internal Number: 212024
Summary:
The System Director, Credentialing Verification Organization (CVO) 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.
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.
- Expert in MD Staff credentialing software
Skills:
- Excellent communication 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
EEO is the law - click below for more information:
https://www.eeoc.gov/sites/default/files/2023-06/22-088_EEOC_KnowYourRights6.12ScreenRdr.pdf
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