Erie Family Health Centers
Associate Director of Credentialing (Hybrid)
Erie Family Health Centers, Chicago, Illinois, United States, 60290
Associate Director of Credentialing (Hybrid)
Join the Erie team! Motivated by the belief that healthcare is a human right, we provide high quality affordable care to support healthier people, families, and communities. Erie delivers holistic care to help every member of the family stay healthy and active from infancy through adulthood. 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. 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, re‑credentialing, 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.
At Erie, we are proud to provide competitive salaries and a full benefits package that includes medical, dental, vision, life and disability insurance, flexible spending accounts for health care or childcare, and a 401(k) program with matching contributions up to 5% of the employee’s biweekly salary. Employees enjoy 20 days of paid time off, eight paid holidays, and opportunities for growth and career advancement.
Compensation
Compensation is based on each candidate’s experience, skills and education within the range identified for the role. Candidates who meet the minimum requirements of the role will start at entry in the range. Any additional skills, experience and education will be reflected in the compensation offered.
Main Duties & Responsibilities
Collaborates with the Director of Credentialing to develop and implement 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 the 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 but not limited to NCQA, HRSA and 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 the Director of Credentialing, Chief Clinical Officer and Compliance Officer; participates in 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
High school diploma or equivalent – required.
Current NAMSS certification as Certified Professional Medical Services Management (CPMSM) or Certified Professional Credentialing Specialist (CPCS) – required.
Preferred Education
Undergraduate or graduate degree in healthcare or business management – a plus.
Dual certification (both CPMSM and CPCS) – a plus.
Experience Required
10 or more years of experience with progressive responsibilities managing the full healthcare credentialing processes, including but not limited to hospital or group practice, central verification office, payer enrollments, medical staff privileging, and database management.
Preferred
At least 5 years of experience in a Central Verification Office – a plus.
Knowledge of NCQA credentialing standards – a plus.
Knowledge of federally qualified health center requirements – a plus.
Skills and Knowledge Required
Proven experience with credentialing and privileging processes, procedures, and maintenance of a central verification office and services.
Comprehensive knowledge of accrediting and regulatory agencies’ standards.
Excellent communication skills, both written and verbal.
Team and workflow management abilities.
Proficiency in managing, querying and analyzing credentialing databases and developing database workflows.
Strong analytical and problem‑solving skills with judgment and initiative.
Strong organization, planning and project management skills.
Computer skills, including proficiency with Microsoft Office programs and credentialing and privileging software and database systems.
Preferred
Working knowledge of credentialing platforms such as Verity, HealthStream or Echo.
Knowledge of National Practitioner Data Bank interface and reporting.
The Erie Advantage Pledge Working Together For What Matters Most
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.
#J-18808-Ljbffr
At Erie, we are proud to provide competitive salaries and a full benefits package that includes medical, dental, vision, life and disability insurance, flexible spending accounts for health care or childcare, and a 401(k) program with matching contributions up to 5% of the employee’s biweekly salary. Employees enjoy 20 days of paid time off, eight paid holidays, and opportunities for growth and career advancement.
Compensation
Compensation is based on each candidate’s experience, skills and education within the range identified for the role. Candidates who meet the minimum requirements of the role will start at entry in the range. Any additional skills, experience and education will be reflected in the compensation offered.
Main Duties & Responsibilities
Collaborates with the Director of Credentialing to develop and implement 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 the 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 but not limited to NCQA, HRSA and 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 the Director of Credentialing, Chief Clinical Officer and Compliance Officer; participates in 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
High school diploma or equivalent – required.
Current NAMSS certification as Certified Professional Medical Services Management (CPMSM) or Certified Professional Credentialing Specialist (CPCS) – required.
Preferred Education
Undergraduate or graduate degree in healthcare or business management – a plus.
Dual certification (both CPMSM and CPCS) – a plus.
Experience Required
10 or more years of experience with progressive responsibilities managing the full healthcare credentialing processes, including but not limited to hospital or group practice, central verification office, payer enrollments, medical staff privileging, and database management.
Preferred
At least 5 years of experience in a Central Verification Office – a plus.
Knowledge of NCQA credentialing standards – a plus.
Knowledge of federally qualified health center requirements – a plus.
Skills and Knowledge Required
Proven experience with credentialing and privileging processes, procedures, and maintenance of a central verification office and services.
Comprehensive knowledge of accrediting and regulatory agencies’ standards.
Excellent communication skills, both written and verbal.
Team and workflow management abilities.
Proficiency in managing, querying and analyzing credentialing databases and developing database workflows.
Strong analytical and problem‑solving skills with judgment and initiative.
Strong organization, planning and project management skills.
Computer skills, including proficiency with Microsoft Office programs and credentialing and privileging software and database systems.
Preferred
Working knowledge of credentialing platforms such as Verity, HealthStream or Echo.
Knowledge of National Practitioner Data Bank interface and reporting.
The Erie Advantage Pledge Working Together For What Matters Most
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.
#J-18808-Ljbffr