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Director Credentialing Operation

4 months ago

Tampa, United States AdventHealth Tampa Full time

All the benefits and perks you need for you and your family:

Paid Days Off from Day One

Career Development

Whole Person Wellbeing Resources

Mental Health Resources and Support

Our promise to you:

Joining AdventHealth is about being part of something bigger. Its about belonging to a community that believes in the wholeness of each person, and serves to uplift others in body, mind and spirit. AdventHealth is a place where you can thrive professionally, and grow spiritually, by Extending the Healing Ministry of Christ. Where you will be valued for who you are and the unique experiences you bring to our purpose-minded team. All while understanding that together we are even better.

Schedule: Full Time

Shift :Days

The community youll be caring for: AdventHealth Tampa

AdventHealth Pepin Heart Institute, known across the country for its advances in cardiovascular disease prevention, diagnosis, treatment and research.

Surgical Pioneers the first in Tampa with the latest robotics in spine surgery

Building a brand new, six story surgical and patient care tower which will ensure state of the art medical and surgical car for generations to come

Awarded the Get With The Guidelines Stroke GOLD Quality Achievement Award from the American Heart Association/American Stroke Association and have been recognized as a recipient of their Target: Stroke Honor Roll for our expertise in stroke care. We have also received certification by The Joint Commission in collaboration with the American Stroke Association as a Primary Stroke Center.

The role youll contribute:

The responsibility of this position is to direct delegated credentialing functions while managing the daily operations of the credentialing and provider enrollment team including selection, training, and supervision of credentialing and enrollment staff. Administers these services with a strong emphasis on the delivery of quality, efficiency and superior service. Implements the policies and standards to ensure that credentialing operations are in compliance with NCQA credentialing standards and CMS. Works with AdventHealth Medical Group (AHMG), AdventHealth leadership, Managed Care Organizations and other departments within AdventHealth to fulfill its mission and goals. Actively participates in outstanding customer service and accepts responsibility in maintaining relationships that are equally respectful to all. service and accepts responsibility in maintaining relationships that are equally respectful to all.

The value youll bring to the team:

Credentialing.

Implement follow-up/quality improvement programs that focus on provider onboarding, data collection, processing, and payer follow-up across AdventHealth within FL.

Provide oversight of credentialing/follow-up for both delegated and non-delegated physician groups and payers.

Collaborate and coordinate with AdventHealth Medical Staff and respective physician organizations (e.g., AHMG) to maintain efficient and effective flow of information and processes.

Maintain effective credentialing processes and standards that are physician-centric and focus on delivering exceptional customer service to the physicians of AHMG and other practice entities.

Provide oversight and guidance to the provider data and credentialing team to ensure all timelines, accuracy of data and work processes are met. Lead the credentialing and data teams and provide management in a way that promotes a positive, motivated working environment embodying the core values of AdventHealth.

Train and provide guidance on an on-going basis with an emphasis on education in credentialing standards, CMS and NCQA guidelines.

Develop and implement revenue management system and processes that facilitate the development of standardized reporting capabilities around payment accuracy and timeliness for all payers for the AdventHealth employed physicians.

Negotiate and maintain delegated credentialing contracts with targeted payers.

Qualifications

The expertise and experiences youll need to succeed:

Masters and 10 years experience

LICENSURE, CERTIFICATION OR REGISTRATION REQUIRED:

Certified Provider Credentialing Specialist (CPCS) certification and/or

Certified Professional Medical Staff Management (CPMSM) certification or

Ability to obtain CPCS or CPMSM within 18 months of hire 3-5 years Leadership Experience

This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances. The salary range reflects the anticipated base pay range for this position. Individual compensation is determined based on skills, experience and other relevant factors within this pay range. The minimums and maximums for each position may vary based on geographical location.

Category: Medical Staff

Organization: AdventHealth Tampa

Schedule: Full-time

Shift: 1 - Day

Req ID: 24021515

We are an equal opportunity employer and do not tolerate discrimination based on race, color, creed, religion, national origin, sex, marital status, age or disability/handicap with respect to recruitment, selection, placement, promotion, wages, benefits and other terms and conditions of employment.