Credentialing Department Manager

    • Job Tracking ID: 2021-1029
    • Job Location: Petaluma, CA
    • Job Level: Management
    • Level of Education: BA/BS
    • Job Type: Full-Time/Regular
    • Date Updated: December 15, 2021
    • Years of Experience: 2 - 5 Years
    • Starting Date: ASAP
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Job Description:

Summary:  The Credentialing Department Manager is responsible for the oversight, supervisor and, when necessary, participating in the daily operations and activities of the credentialing department to ensure that LIP, OLCP, and OCS staff credentialing applications are processed accurately, in a timely manner and in accordance with Joint Commission (TJC), HRSA and PHC standards and guidelines thereby ensuring that only qualified practitioners provide care at PHC. The Credentialing Department Manager is responsible for effectively working with the credentialing team, clinicians and HR to create and facilitate a seamless credentialing experience.  

 

The Credentialing Department Manager works in collaboration with the Human Resources Department and hiring team for newly hired staff, and collaborates extensively with the Compliance Officer, clinical staff members, the Medical Director, and Occupational Health Staff.

 

Areas of Responsibility:  

  • Manages with integrity, honesty, and knowledge needed to promote the culture, values, and mission of Petaluma Health Center.
  • Help lead and monitor all credentialing, re-credentialing, and provider enrollment processes in the credentialing department
  • Implement and monitor ongoing audits of the credentialing department’s work, ensuring effective and efficient audit execution while identifying objectives and errors, using data and information as an opportunity to improve the process and understand errors in order to implement improvement plans
  • Prepare audit and operational reports and credentialing files for presentation to the CAO, the CCO, the CMO, the Credentialing Committee, the Risk Management Committee and the Board of Directors, as needed
  • Ensure staff coordination and administration of the credentialing process for certified staff and providers at PHC. This includes, but is not limited to, ensuring and/or verifying required information for certified staff / providers necessary for compliance with our credentialing, re-credentialing and privileging process
  • When identified, review background checks with alerts and escalating to the CAO and, when necessary, the CMO
  • Manage Student Credentialing by developing and implements new policies and procedures with the goal of streamlining the process, acting as a contact point for student credentialing and compliance Review, develop, and maintain Credentialing policies and Procedures, Background Check Policies and Procedures and other policies and procedures pertaining to the Credentialing Department on a continual basis to ensure compliance with approving authorities and PHC standards.
  • Develop, implement and manage processes to create, update and maintain practitioner files for enrollment purposes and for ensuring accurate and timely completion of credentialing and practitioner enrollment
  • Effect interdepartmental collaboration and coordination to maximize efficiency and effectiveness of practitioner credentialing and enrollment as well as to maintain documentation necessary for verification and credentialing delegation of the organization
  • Identify and communicate all concerns regarding practitioner credentialing and enrollment to appropriate parties, following up when necessary to ensure affected parties, and departments are notified of concerns in an appropriate time frame
  • Ensure staff track applications through the practitioner initial and re-credentialing processes to ensure timely credentialing and completed enrollment dates are obtained prior to or as close as possible to the practitioner start date
  • Ensure compliance with HRSA, TJC and PHC standards and guidelines; identify and monitor additional accreditation policies and other federal and state legislation, as appropriate. Maintain and seek further training and expertise regarding credentialing practices, standards, requirements, etc. while seeking advanced certifications
  • Provide management support to the Credentialing Department, including but not limited to the Compliance Coordinator, the Credentialing Specialist(s) and/or Credentialing Assistant(s)
  • Review, analyze and create practitioner credentialing applications, privileging forms and standardized communications in an effort to improve customer service, communication and compliance
  • Lead department in providing the highest levels of customer service and care to all internal staff and external applicants, contacts, etc. 
  • Ensure staff orients credentialing candidates and newly hired providers to the credentialing process and serves as their primary contact regarding the status of credentialing and re-credentialing applications
  • Ensure the Credentialing Department collaborates with HR to obtain copies of job descriptions, review for compliance and develop time sensitive corrective action plan(s) to address and remedy deficiencies
  • Effectively implement and improve the operational processes of the Credentialing Department to achieve maximum efficiency, accuracy and data integrity
  • Ensure excellent customer service in the Credentialing Department, monitoring and keeping the CAO informed of issues relating to the physician-credentialing relationship
  • Ensure staff collaborate with managers, directors and providers to obtain copies of licensures, certificates, diplomas, and various required HR documents, verifying their validity as part of the initial and re-credentialing process
  • Oversee the project management for the transition to an electronic credentialing system
  • Oversee the development, evaluation, and optimization of training programs on the Credentialing process and Credentialing electronic software/systems.
  • Perform additional job-related duties as assigned

Experience and Skills:

Qualifications: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required.  

 

Education/Experience:

Bachelor's Degree or equivalent practical experience preferred

  • Experience in FQHC or hospital credentialing preferred
  • Experience managing a team accurately under time pressures preferred
  • Experience managing and communicating across a diverse team and organization preferred
  • CPMSM or CPCS certification preferred

 

Desired Skills:

  • The professional integrity to adhere to professional confidentiality standards in accordance with legal, ethical and company policies
  • Performs in a self-motivated, self-starter fashion. Must be energetic, organized, a fast learner and thrive in a fast-paced environment
  • The flexibility to adjust work schedules as needed to ensure completion of assignments within required deadlines and to independently perform work assignments and projects
  • Strong attention to detail
  • Ability to multi-task, prioritize and successfully manage multiple time-sensitive and urgent projects and requests
  • Strong communication skills with the ability to accurately relay information to a team

 

Language Skills:  Ability to read, analyze and interpret common technical journals, financial reports and legal documents. Ability to communicate with customers, regulatory agencies or members of the business community.

 

Mathematical Skills:  Ability to add, subtract, multiply, divide in all units of measure, using whole numbers, common fractions and decimals at college level.

 

Reasoning Ability:  Ability to recognize problems, collect data and establish facts quickly and under deadlines. The critical thinking skills to exercise good judgment and discretion in applying departmental policies and procedures while handling confidential medical staff, risk management and peer review information.

 

Computer Skills:  Knowledge of word processing and spreadsheet software, Human Resource systems and Database software. Proficient in Microsoft Word, Excel and Outlook.

 

Physical Demands:  The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

  • Movement within health center complex environment repeatedly throughout the day
  • Ability to write by hand, use phone, use computer keyboard and mouse extensively to perform general office functions
  • Manual wrist and finger dexterity and wrist-finger speed sufficient to perform repetitive actions for extended periods of time
  • Ability to effectively communicate by hearing continuously and speech in a manner which can be understood by a diverse population
  • Ability to give and follow verbal and written instructions with attention to detail and accuracy
  • Must have visual acuity near and far (20 inches to 20 feet), depth perception, field of vision, ability to focus on an object, ability to identify and distinguish colors
  • Ability to sit or stand for extended periods of time (minimum periods of one (1) hour at a time)  
  • Ability to frequently walk, bend, squat, stoop, kneel, twist, crouch, and climb with the use of a step stool
  • Ability to grasp, hold and pick up and reach with hands and arms
  • Ability to frequently lift and or move up to fifteen (15) pounds

Ability to occasionally lift and carry up to thirty (30) pounds (periodic lifting of supplies or equipment) 

  • Ability to coordinate multiple tasks simultaneously
  • Ability to travel to and from other health center sites and community locations