Erie Family Health Centers
Associate Director of Credentialing
Erie Family Health Centers, Chicago, Illinois, United States, 60290
Overview
Associate Director of Credentialing (Hybrid) – Erie Family Health Centers. Erie Family Health Centers, a nationally recognized top workplace with 13 sites in Chicago and suburbs, is looking for a valuable addition to our Credentialing team. The Associate Director of Credentialing supports the Director of Credentialing by overseeing initial credentialing, recredentialing, privileging, and ongoing monitoring of credentials and regulatory requirements for all licensed and credentialed providers and employees of Erie Family Health Centers; responds to regulatory changes and assists with strategic directions to ensure operational efficiency and compliance with all credentialing-related functions; develops implementation tools, techniques, and evaluation protocols to oversee and improve a centralized process and to maintain high standards for compliance. Erie believes healthcare is a human right and provides high quality affordable care to support healthier people, families, and communities. Since 1957, we have provided high-quality care to diverse patients most in need, regardless of their insurance status, immigration status, or ability to pay. Main Duties & Responsibilities
Collaborates with the Director of Credentialing with developing and implementing policies and protocols necessary to verify and ensure that Erie licensed independent practitioners and other licensed and certified clinical staff are processed in accordance with Erie and industry practice standards and ensures successful results on external surveys or audits of regulatory practices. Supervises, trains and coaches Credentialing Specialists, new and current, to ensure performance outcomes for department’s goals. Directs and oversees all aspects of credentialing processes to ensure compliance with all standards, bylaws, state and federal requirements, accreditation standards (including NCQA, HRSA, CMS), payer plans and enrollments, immigration support, professional liability coverage and protections, and Human Resources. Manages all disclosures of claims history, adverse and disciplinary actions with Director of Credentialing, Chief Clinical Officer, and Compliance Officer. Participates with submission of regulatory reporting of disclosures to hospitals, payer plans, and to State and federal agencies. Maintains knowledge of current and changing regulatory requirements and assists with necessary policy revisions, communication of changes to credentialing specialists, HR and provider leadership, and other Erie employees and business partners. Qualifications
Education
Required:
High School diploma or equivalent required Current NAMSS Certification as Certified Professional Medical Services Management (CPMSM) or Certified Professional Credentialing Specialist (CPCS) Preferred:
Undergraduate or graduate degree in healthcare or business management a plus. Dual certification a plus (both NAMSS CPMSM and CPCS) Experience
Required:
Current ten (10) or more years of experience with progressive responsibilities managing the full healthcare credentialing processes, including hospital or group practice, central verification office, payer enrollments, medical staff privileging, and database management. Preferred:
Five (5) or more years of experience in a Central Verification Office Knowledge of NCQA credentialing standards Knowledge of federally qualified health center requirements Skills & Knowledge
Required:
Proven experience with credentialing and privileging processes and maintenance of a central verification office, including developing and editing privileges forms and criteria. Comprehensive knowledge of accrediting and regulatory agencies’ standards. Effective written and verbal communication; professional interaction with individuals and groups. Ability to manage teams, workflows, and credentialing databases. Strong analytical, problem-solving, organization, and project management skills. Proficiency with Microsoft Office and credentialing software/database administration. Preferred:
Knowledge of Verity, HealthStream, or Echo credentialing platforms Knowledge of National Practitioner Data Bank interface and reporting The Erie Advantage Pledge
Working Together For What Matters Most
Erie makes a pledge that all current and future employees can feel confident that: Our mission, vision, and values unite us. Our voices matter. We do things well. Our inclusive culture promotes balance and belonging. We find our career sweet spot at Erie. Seniority level
Mid-Senior level Employment type
Full-time Job function
Human Resources Industries: Hospitals and Health Care
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Associate Director of Credentialing (Hybrid) – Erie Family Health Centers. Erie Family Health Centers, a nationally recognized top workplace with 13 sites in Chicago and suburbs, is looking for a valuable addition to our Credentialing team. The Associate Director of Credentialing supports the Director of Credentialing by overseeing initial credentialing, recredentialing, privileging, and ongoing monitoring of credentials and regulatory requirements for all licensed and credentialed providers and employees of Erie Family Health Centers; responds to regulatory changes and assists with strategic directions to ensure operational efficiency and compliance with all credentialing-related functions; develops implementation tools, techniques, and evaluation protocols to oversee and improve a centralized process and to maintain high standards for compliance. Erie believes healthcare is a human right and provides high quality affordable care to support healthier people, families, and communities. Since 1957, we have provided high-quality care to diverse patients most in need, regardless of their insurance status, immigration status, or ability to pay. Main Duties & Responsibilities
Collaborates with the Director of Credentialing with developing and implementing policies and protocols necessary to verify and ensure that Erie licensed independent practitioners and other licensed and certified clinical staff are processed in accordance with Erie and industry practice standards and ensures successful results on external surveys or audits of regulatory practices. Supervises, trains and coaches Credentialing Specialists, new and current, to ensure performance outcomes for department’s goals. Directs and oversees all aspects of credentialing processes to ensure compliance with all standards, bylaws, state and federal requirements, accreditation standards (including NCQA, HRSA, CMS), payer plans and enrollments, immigration support, professional liability coverage and protections, and Human Resources. Manages all disclosures of claims history, adverse and disciplinary actions with Director of Credentialing, Chief Clinical Officer, and Compliance Officer. Participates with submission of regulatory reporting of disclosures to hospitals, payer plans, and to State and federal agencies. Maintains knowledge of current and changing regulatory requirements and assists with necessary policy revisions, communication of changes to credentialing specialists, HR and provider leadership, and other Erie employees and business partners. Qualifications
Education
Required:
High School diploma or equivalent required Current NAMSS Certification as Certified Professional Medical Services Management (CPMSM) or Certified Professional Credentialing Specialist (CPCS) Preferred:
Undergraduate or graduate degree in healthcare or business management a plus. Dual certification a plus (both NAMSS CPMSM and CPCS) Experience
Required:
Current ten (10) or more years of experience with progressive responsibilities managing the full healthcare credentialing processes, including hospital or group practice, central verification office, payer enrollments, medical staff privileging, and database management. Preferred:
Five (5) or more years of experience in a Central Verification Office Knowledge of NCQA credentialing standards Knowledge of federally qualified health center requirements Skills & Knowledge
Required:
Proven experience with credentialing and privileging processes and maintenance of a central verification office, including developing and editing privileges forms and criteria. Comprehensive knowledge of accrediting and regulatory agencies’ standards. Effective written and verbal communication; professional interaction with individuals and groups. Ability to manage teams, workflows, and credentialing databases. Strong analytical, problem-solving, organization, and project management skills. Proficiency with Microsoft Office and credentialing software/database administration. Preferred:
Knowledge of Verity, HealthStream, or Echo credentialing platforms Knowledge of National Practitioner Data Bank interface and reporting The Erie Advantage Pledge
Working Together For What Matters Most
Erie makes a pledge that all current and future employees can feel confident that: Our mission, vision, and values unite us. Our voices matter. We do things well. Our inclusive culture promotes balance and belonging. We find our career sweet spot at Erie. Seniority level
Mid-Senior level Employment type
Full-time Job function
Human Resources Industries: Hospitals and Health Care
#J-18808-Ljbffr