Manager, Credentialing

6 days ago

Atlanta, Georgia, United States Istituto Marangoni Full time
Overview

The

Manager, Credentialing & HR Compliance

at Emory Healthcare (EHC) is a pivotal role responsible for overseeing all aspects of credentialing for all EHC licensed clinicians.

This individual ensures that all non-provider roles across EHC meet the necessary qualifications, certifications, and standards required to deliver quality care and comply with regulatory requirements on an ongoing basis.

The Credentialing & HR Compliance Manager works closely with various stakeholders, including staff, administration, and regulatory agencies, to streamline processes and maintain compliance.


Minimum Requirements:
Bachelors degree in healthcare administration, business administration, or a related field required.
Minimum of 3 years of experience in healthcare credentialing, with progressively increasing levels of responsibility and leadership.

Certification in healthcare credentialing (e.g., Certified Provider Credentialing Specialist - CPCS, Certified Professional Medical Services Management - CPMSM) or certification in HR (e.g., SHRM-SCP, HRCI) strongly preferred.

In-depth knowledge of credentialing standards, regulations, and best practices, including those set forth by NCQA, CMS, and other accrediting bodies.

Excellent communication, interpersonal, and problem-solving skills.
Strong attention to detail and organizational skills.
Proficiency in credentialing software systems and Microsoft Office applications.
Ability to work independently, prioritize tasks, and manage multiple projects simultaneously.
Ability to work collaboratively across departments and with external partners.
Familiarity with HRIS systems and software applications.
Description

Leadership
Provide strategic direction in the creation and management of a centralized credentialing and compliance team to reside in Human Resources
Develops and implements policies and standard operating procedures for credentialing and licensing of clinicians
Manages and supervises the credentialing and licensure team, including hiring, training, coaching, and evaluating performance; identifying the key skills required for a high performing team
Identifies best practices and processes to maintain the highest level of compliance possible
Identifies meaningful KPIs for the team by developing key metrics to hold team accountable to policies and SOPs as it relates to credentialing and compliance
Supports and cultivates an environment of inquiry to ensure team members feel supported and engaged
Credentialing
Develops, implements, and oversees credentialing processes and procedures to ensure efficiency, accuracy, and compliance with healthcare industry standards and regulations
Monitors and tracks credentialing timelines to ensure timely completion and compliance with organizational and regulatory requirements
Serves as the primary point of contact for credentialing-related inquiries from staff, administration, and regulatory agencies
Participates as a subject matter expert in credentialing staff processes during entity regulatory agency visits, as appropriate, in conjunction with operations and HR partners
Stays current with all regulations, licensing standards, and job requirements related to credentialing and minimum qualifications
Conducts regular audits and quality assessments of credentialing processes to identify areas for continuous improvement and ensures compliance with regulatory standards
Implements corrective actions and training programs as needed to address deficiencies and enhance credentialing practices
Develops and delivers training programs for staff involved in credentialing processes to promote understanding of regulatory requirements, best practices, and system usage
Provides ongoing education and support to operational leaders and staff regarding credentialing standards, requirements, and expectations
General Compliance

Collaborates with partnering HR teams to ensure compliance with all EHC employment requirements, including annual regulatory training, flu vaccinations, etc.

Partners with HR Business Partners and other HR teams to help entities operate ready for any state or federal regulatory visits
Monitors HR practices and processes to identify areas of potential legal risk and implements corrective actions as necessary
Collaborates with legal counsel as needed to address compliance-related issues
Conducts regular audits of HR practices, records, and processes to ensure compliance
Monitors key metrics and indicators to identify trends or issues requiring attention
Provides direction to team for day-to-day activities to include:
Verifying professional licenses, certifications, and education credentials passed from talent acquisition onboarding team
Maintains accurate credentialing documentation
Updates and maintain credentialing software with current information
Monitors license and certification issues to include upcoming expirations, changes in status, missing/unverified information, sanctions, etc.
Communicates with employees to obtain missing or incomplete information
Communicates credentialing issues with operational leaders and HR leaders and partners to ensure employees with issues are not on schedules
Ensure compliance with all regulatory requirements and accreditation standards
Provides support with compliance requirements and initiatives

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