Senior Director, Credentialing Verification Organization

2 weeks ago

Wethersfield, United States Hartford HealthCare Full time

Description

Job Schedule: Full Time

Standard Hours: 40

Job Shift: Shift 1

Shift Details:

Work where every moment matters.

Every day, over 30,000 Hartford HealthCare colleagues come to work with one thing in common: Pride in what we do, knowing every moment matters here. We invite you to become part of Connecticut's most comprehensive healthcare network.

Hartford HealthCare's unified culture enhances access, affordability, equity and excellence. Its care-delivery system- with more than 500 locations serving 185 towns and cities- includes two tertiary-level teaching hospitals, an acute-care community teaching hospital, an acute-care hospital and trauma center, three community hospitals, a behavioral health network, a multispecialty physician group, a clinical care organization, a regional home care system, an array of senior care services, a mobile neighborhood health program and a comprehensive physical therapy and rehabilitation network. On average, Hartford HealthCare touches more than 23,000 lives every single day. The unique, system-wide Institute Model offers a unified high standard of care in crucial specialties at hospital and ambulatory sites across Connecticut offering unparalleled expertise at the most affordable cost. The institutes include: Ayer Neuroscience, Behavioral Health, Cancer, Digestive Health, Heart and Vascular, Orthopedics and Tallwood Urology & Kidney.

Position Summary:

The Senior Director will provide\ strategic leadership to the HHC System Credentialing Verification Organization (CVO), Medical Staff Office (MSO) and Provider Enrollment teams (PE). Overseeing the departmental operations, the Senior Director will assure the delivery of superior credentialing verification services and privileging for all hospital entities, their medical staffs, and any contracted clients. The Senior Director will have oversight for credentialing and provider enrollment and medical staff functions for all HHC employed providers, assuring timely enrollment of all HHC facilities and medical groups with payers.

Key Accountabilities:

* Leads medical staff offices and collaborates with medical staff leadership and executive leadership
* Researches and implements tools and solutions to support and optimize the CVO/MSO/PE
* Develops and ensures metrics, goals, and projects are documented, executed, tracked, and accomplished
* Maintains a thorough and working knowledge of important industry standards set forth by organizations such as the Joint Commission, NCQA, CMS, etc.
* Develops policies, procedures and standard work for the CVO/MSO/PE in accordance with standards, rules, regulations and medical staff bylaws
* Provides continuous feedback to Executive Staff as it relates to observed issues with staff, customer concerns, volume of work
* Creates and monitors standard work for medical staff credentialing, provider enrollment & MSO processes
* Benchmarks with national professional organizations and other PE organizations to determine best practices for provider enrollment
* Establishes standards for turnaround time and monitors performance relative to those standards
* Oversees the data integrity and functionality of credentialing and enrollment databases
* Responsible for ensuring that the credentialing data is accurate and available for other systems to utilize as their source
* Evaluates key financial, budgetary and other metrics related to operations
* Provides information forecasts, trends or other conditions that may affect operations or budget planning
* Participates in the development of FTE budgetary expenses, operational expenses and capital budgets
* Provides orientation, education and training of staff regarding business practices, standards, regulations
* Coaches and mentors staff, utilizing H3W leadership behaviors

Qualifications

* Bachelor's Degree is required. Master's degree in health care related field or equivalent is preferred
* Five plus years of experience in Medical Staff Services with management experience
* CPCS Certification is required. CPMSM (Certified professional Medical Staff Management) from NAMSS certification is preferred.
* Understanding of the credentialing and privileging processes for hospitals and ambulatory care settings and provider enrollment
* Ability to work with multiple application specific databases
* Advanced knowledge of medical terminology
* Ability to work within and promote a team environment
* Ability to work on multiple projects and deadlines and to support medical staff leaders and functions.
* Strong analytical skills
* Expert knowledge of JC and NCQA standards, as well as federal and state regulations with regard to medical staff credentialing
* Excellent written and verbal communication skills, organizational ability, interpersonal skills and customer service orientation
* Foundational experience in quality improvement approaches such as LEAN

We take great care of careers.

With locations around the state, Hartford HealthCare offers exciting opportunities for career development and growth. Here, you are part of an organization on the cutting edge - helping to bring new technologies, breakthrough treatments and community education to countless men, women and children. We know that a thriving organization starts with thriving employees-- we provide a competitive benefits program designed to ensure work/life balance. Every moment matters. And this is your moment.

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