Compliance Officer and Credentialing Manager

3 weeks ago


Chicago, Illinois, United States JobSuite Full time
Job Title: Chief Compliance Officer and Credentialing Manager

Job Summary:
JobSuite is seeking a seasoned Compliance Officer and Credentialing Manager to lead our organization's compliance program and provider credentialing department. As a key member of our team, you will be responsible for ensuring our compliance program meets the highest standards and our provider credentialing process is efficient and effective.

Key Responsibilities:
  • Serve as chair of the organization's compliance committee, developing agendas and meeting materials, and ensuring meetings are properly documented.
  • Ensure compliance and privacy policies and procedures reflect current regulatory standards and industry guidance, collaborating with Regional and Office managers to implement policies across all applicable business lines.
  • Collaborate with various leaders to conduct compliance investigations, keeping owners and key stakeholders informed of results.
  • Serve as a resource for clinical and administrative leadership on compliance policies and related matters, including evaluating compliance risk associated with business initiatives.
  • Manage and oversee the organization's peer review/chart audit function, ensuring chart reviews meet established guidelines and addressing concerns identified in the process.
  • Ensure quality matters are properly addressed and accounted for in the provider credentialing system.
  • Oversee the provider enrollment and credentialing function, chairing the credentialing committee and ensuring organizational policies and performance metrics are met while establishing positive relationships with new employees.
  • Address bottlenecks in the credentialing process through collaboration with insurance company management personnel and provider relations team members.

Requirements:
  • At least 5 years of healthcare compliance program experience, preferably in a multi-site dental or medical office setting.
  • Demonstrated track record of effectively working with administrative and clinical leadership to accomplish various compliance program-related matters.
  • Ability to work independently to identify bottlenecks in processes and create solutions to increase efficiency and effectiveness of business processes.


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