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Senior Manager, Credentialing and Accreditation
2 months ago
Job Summary:
As a Senior Manager, Credentialing and Accreditation at University Health System- San Antonio, you will be responsible for implementing and overseeing the credentialing and recredentialing program of practitioners and providers. This includes entities delegated for credentialing, in accordance with regulatory and accreditation standards.
Key Responsibilities:
- Monitor regulatory, contractual, and accreditation standards and implement policy and procedural changes as necessary.
- Collaborate with consortium health plans in the review and coordination of contractual requirements for the verification process by the state Credentialing Verification Organization.
- Coordinate research and Credentialing Committee reports of initial practitioners who have issues with their credentials and reports from the licensing and monitoring organizations.
- Coordinate with the Chief Medical Officer or designee for administration of the Credentialing Committee and Committee actions.
Requirements:
- An associate degree in a healthcare-related or business management field or five years of equivalent experience related to the duties and responsibilities specified is required.
- Excellent written and oral communication, problem-solving, organizational skills, statistical, and analytical abilities are required.
- Knowledge of accreditation credentialing standards (such as NCQA), federal, state, and regulatory agency requirements with reference to verification of physician/allied health professional credentials is required.
- At least five years of supervisory experience in a managed care setting with exposure to multiple product lines and communication with regulatory agencies is preferred.
Preferred Qualifications:
- NAMSS Certification as Certified Provider Credentials Specialist (CPCS) is preferred.
