Compliance Officer and Credentialing Manager
3 weeks ago
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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