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Credentialing Manager

2 months ago

Orlando Florida, United States Orlando Health Full time
Job Summary

Orlando Health is seeking an experienced Credentialing Manager to oversee the Credentialing Verification Office (CVO) team, responsible for providing various aspects of credentialing verifications for providers to see patients and meet all regulatory guidelines.

Key Responsibilities
  • Manage primary source verifications, recredentialing functions, and customer services aspect of the CVO.
  • Lead CVO in customer service needs, building a team of subject matter experts, and enhancing Orlando Health onboarding turnaround times.
  • Accountable for Service Line Agreements with stakeholders of the CVO, including Medical Staff Services, site Credentialing Committees, and local Medical Staff Offices.
  • Accountable for Key Performance Indicators associated with team performance and turnaround times.
  • Act as primary source of truth for data feeding all downstream systems, accountable for data integrity.
  • Participate in Provider Data Governance Council in role of data steward.
  • Direct responsibility for all provider follow-up, including external and internal media pages.
  • Manage the accurate and timely credentialing of Orlando Health employed and contracted physicians, allied health professional staff, and hospital facilities with managed care plans and governmental payors.
  • Develop full understanding of and expertise in National Committee for Quality Assurance (NCQA) credentialing standards and ensure that all Orlando Health credentialing processes meet those criteria.
  • Maintain current knowledge of governmental compliance, regulations, policies, and protocols and assess the impact on credentialing processes.
  • Develop and implement processes to ensure timely and accurate compliance with all governmental entities affecting credentialing and ultimately physician and professional staff revenue.
  • Develop, implement, and manage current managed care credentialing processes.
  • Identify and resolve departmental issues related to credentialing and develop performance improvement plans as necessary.
  • Research, develop, and manage credentialing action plans for new system endeavors related to employed physician practices and/or changes associated with state and federal regulations impacting Medicare and Medicaid credentialing.
  • Prepare status reports and recommendations for Director of Managed Systems.
  • Manage, assign, prioritize, and distribute workload of Credentialing Specialists.
  • Facilitate presentation of monthly credentialing files to Orlando Health Credentialing Committee.
  • Actively participate on other physician committees and task forces, as necessary.
  • Handle escalated credentialing items requiring attention and notify Department Director of such.
  • Responsible for mitigating financial risk to the organization by managing to proper credentialing policies and procedures and ensuring timely and accurate credentialing of all Orlando Health entities.
  • Interact and communicate with physicians, administrators, and numerous departments both internal and external to Orlando Health.
  • Develop and maintain strong business relationships with managed care plans, and Medicare and Medicaid governmental state of Florida and federal entities to facilitate timely credentialing.
  • Manage physician credentialing database and take steps necessary to ensure integrity of the data maintained.
  • Implement and manage credentialing system, MD Staff, and applicable applications, to ensure system is being used to its' maximum potential.
  • Address and resolve internal and external issues related to physician credentialing.
  • Supervise credentialing team and administer coaching plans, counseling, and guidance to all team members.
  • Manage various personnel functions including hiring, work assignments, coaching plans, and disciplinary actions.
  • Review team performance, effect changes as needed to improve service.
  • Handle training process of new credentialing team members.
  • Ensure credentialing department maintains confidentiality of all credentialing specific information.
  • Maintain reasonably regular, punctual attendance consistent with Orlando Health policies, the ADA, FMLA, and other federal, state, and local standards.
  • Maintain compliance with all Orlando Health policies and procedures.
Qualifications
  • Education/Training: High School Diploma.
  • Licensure/Certification: Certified Provider Credentialing Specialist (CPCS) - Preferred, Certified Professional Medical Services Management (CPMSM) - Preferred.
  • Experience: Seven (7) year's applicable credentialing experience. A Bachelor's degree may substitute for 3 years of the required experience.