Vice President of Credentialing and Licensing

3 weeks ago

Atlanta, United States TeleSpecialists LLC Full time
Job DescriptionJob DescriptionSummary

The Vice President of Credentialing & Licensure is responsible for overseeing the credentialing, hospital privileging and state licensure processes for all providers who deliver telemedicine services through our platform. The Vice President of Credentialing & Licensure is senior leader responsible for strategic planning, forecasting, development of the team and division. This position reports to the Chief Administrative Officer (CAO) and works closely with other senior leaders, clinical staff, and external partners.

Essential Duties & Responsibilities
  • Develop and implement policies and procedures for credentialing and licensing of providers, including initial applications, reappointments, and ongoing monitoring.
  • Manage and supervise the credentialing and licensure team, including hiring, training, coaching, and evaluating performance.
  • Ensure timely and accurate completion of credentialing and licensing activities, including verification of education, training, licensure, certification, malpractice, and references.
  • Strategizes, develops, and oversees multiple departmental functions to support contracted facilities and licensure across all states.
  • Communicates with new/potential customers alongside the sales and implementation teams to ensure smooth implementation of services and as subject matter expert for Licensing and Credentialing requirements.
  • Maintain and update the credentialing and licensure database and system, ensuring data integrity and security.
  • Monitor and report on the status and outcomes of credentialing and licensing activities, including quality indicators, performance metrics, and audit results.
  • Identify and resolve any issues or discrepancies related to credentialing and licensing, including appeals, complaints, and investigations.
  • Establish and maintain effective communication and collaboration with providers, clients, regulators, accreditors, and other stakeholders.
  • Ensures compliance with federal, state, and local regulations, as well as accreditation standards from The Joint Commission (TJC) or National Committee for Quality Assurance (NCQA).
  • Stay abreast of current trends and best practices in credentialing and privileging, as well as changes in laws, rules, and standards that may affect the organization.
  • Participate in strategic planning and quality improvement initiatives related to credentialing and licensure.
  • Develop trending reports to identify areas of opportunity, areas of success, and to determine if any other process enhancements are needed.
  • Presents at leadership team meetings with periodic reporting and KPI’s to highlight division performance, identifying concerns and opportunities for improvements and reporting on division progress.
  • Partners with Director of Capacity Planning to prioritize inventory and forecast need for additional credentialing and licensing.
Qualifications
  • Demonstrates ability to lead, manage and motivate teams.
  • Ability to interact with internal and external customers and navigate difficult customer conversations or escalations.
  • Familiarity with The Joint Commission (TJC) or National Committee for Quality Assurance (NCQA) accreditation standards and requirements.
  • Experience with telemedicine provider credentialing and licensure preferred.
  • Excellent verbal and written communication skills, with the ability to communicate effectively with diverse audiences and stakeholders.
  • Strong analytical and problem-solving skills, with the ability to manage complex and sensitive issues.
  • High attention to detail and accuracy, with the ability to meet deadlines and prioritize multiple tasks.
  • Proficient in Microsoft Office applications and credentialing and licensure software systems.
Education/Experience
  • Bachelor's degree in healthcare administration, business administration, or a related field. Master's degree preferred.
  • Minimum of 10 years of experience in provider credentialing with a large physician practice, CVO, healthcare system or hospital.
  • Experience with telemedicine provider credentialing and licensure preferred.
  • Minimum of 5 years of experience in a leadership or management role, preferably in a credentialing and licensure department or function.
  • Certified Provider Credentialing Specialist (CPCS) or Certified Professional Medical Services Management (CPMSM) credential required.

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