Credentialing & Provider Enrollment Manager

Company Intro:

At American Vision Partners (AVP), we partner with the most respected ophthalmology practices in the country and integrate best-in-class management systems, operational infrastructure, and advanced technology to provide the highest quality patient care possible. Our practices include Barnet Dulaney Perkins Eye Center, Southwestern Eye Center, Retinal Consultants of Arizona, M&M Eye Institute, Abrams Eye Institute, Southwest Eye Institute, Aiello Eye Institute, Moretsky Cassidy Vision Correction, Wellish Vision Institute, West Texas Eye Associates and Vantage Eye Center. We are focused on building the nation's largest and most comprehensive eye care practices and currently operate more than 100 eye care centers in Arizona, New Mexico, Nevada, California and Texas – including 25 ambulatory surgical centers.

At AVP we value teamwork, providing exceptional experiences, continuous improvement, financial strength, and hard work. We are committed to providing best-in-class patient care, pioneering research and technology, and most importantly, rewarding and recognizing our employees

Responsibilities:

• Provides leadership and management expertise to the Credentialing and Provider Enrollment Department.
• Plans, organizes, directs and effectively manages the responsibility for overseeing the day-to-day operations of the Provider Enrollment and Credentialing teams by creating a positive environment that encourages staff to perform at their highest potential.
• Oversees the hiring, training, and supervision of department staff. Ensures that department policies are fairly administered by overseeing corrective action process, employee training, mentoring and coaching employees and supervisors as well as completing performance reviews.
• Ensures departmental standards by efficiently setting goals and objectives, assisting with the prioritization of work, and using available resources.
• Initiates and facilitates the Credentialing and Provider Enrollment process.
• Communicate regularly with payers and know when and how to appropriately escalate issues for resolution.
• Communicates performance data and action plans to leadership.
• Maintains and analyzes department statistics on work volume, productivity and accuracy for use in long-range planning.
• Manages the processing and submission of provider enrollment applications with the payers in a timely and accurate manner.
• Effectively delegate duties in order to manage productivity and effectively manage time.
• Accountable for establishing, contributing, and implementation of standards applicable to provider staff relating to credentialing and administrative functions in compliance with credentialing, licensing and accreditation requirements.
• Effectively does own due diligence and research and establishes solutions to bridge gaps in work processes that have disconnected due to turnovers, staff shortages or other extenuating circumstances.
• Works without boundaries and advances own knowledge of other processes outside of the immediate job responsibilities. Maintains positive leadership and gives frequent performance feedback, and encourages two-way participation and ideas.
• Provides a collegial environment which fosters teamwork within the department's teams and as well as other inter-organization departments.
• Conducts self-audits and provides reports and important information to department director continuously and timely.
• Prepares key credentialing operational reports for internal customers that drive business decisions and impact strategic planning.
• Maintains comprehensive knowledge of both state and federal requirements to ensure that all legal, licensure and accreditation standards, due dates and deadlines are met.
• Assures credentialing activities are integrated within the appropriate organization's committees and departments.
• Responsible for hiring, training, coaching, reviewing job performance and counseling all direct report staff. Provides coaching to employees when needs are identified, holding employees accountable for results through coaching and development of action plans.
• Performs all other assigned duties.

Qualifications:

• Bachelor's Degree or equivalent experience
• Requires 5 or more years in a supervisory or leadership role
• Requires at least 5 years' experience in credentialing & privileging
• Ideal candidate will have additional experience in provider enrollment
• Current Certified Provider Credentialing Specialist (CPCS) or Certified Professional Medical Staff Management (CPMSM) with the National Association of Medical Staff Services is required to effectively understand and apply credentialing processing, standards and guidelines.

Benefits & Perks:

Your health, happiness and your future matters At AVP, we offer everything from medical and dental insurance, significant eye care discounts, child care assistance, pet insurance, continuing education funds, 401(k), paid holidays, PTO, Sick Time, opportunity for growth, and much more