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Credentialing Customer Service Manager in Houston at Parallon

Date Posted: 3/18/2019

Job Snapshot

Job Description

The Manager of Credentialing Shared Services in the Shared Services Division (SSD) should possess a strong background in data analysis and credentialing. This includes proactively identifying issues, coordinating issue resolution, and monitoring events to determine educational opportunities. This also involves monitoring performance to identify best practices and working with the SSD AVP Credentialing Shared Services to implement these across the operations. Additionally, this includes developing applicable credentialing policies and procedures and providing input related to Cactus credentialing system. This individual will play a key role in linking operations and systems (working closely with IT&S) in that these functions must be in sync in terms of compliance parameters. This individual is a liaison between the SSD, applicable HCA Corporate Departments (e.g., Legal, Quality Standards, and Information Technology & Services), and CPC personnel regarding credentialing issues. They will participate in Internal Audit and QRS processes (program development, resolution of issues, etc.) related to compliance in the CPCs and will work with the CPCs to address identified issues. This individual must demonstrate strong commitment to stakeholder relationships by taking ownership of issues and facilitating effective outcomes in a timely manner.

Possesses a detailed understanding of credentialing operations and the Cactus credentialing systems • Stays abreast of and communicates effectively regarding federal and multi-state regulatory requirements, emerging industry trends and company policies
• Proactively identifies and researches potential payroll issues and recommends courses of action
• Conducts investigations resulting from communicated issues
• Performs onsite operational assessments of CPC operations, makes recommendations for improvements and ensures implementation of action plans
• Provides applicable documentation; which may include regulations, to support recommended courses of action
• Develops best practice documentation and implementation plans
• Works with Internal Audit to develop and enhance audit plans and procedures
• Reviews internal and external audit reports and investigation reports relating to the CPC and ensures appropriate corrective and preventative actions have been taken
• Develops periodic communication tool for CPC distribution and conducts periodic conference calls to discuss issues and opportunities for improvement
• Keeps SSD leadership informed of the status of issues at the CPCs via a specific reporting mechanism
• Acts as a resource to CPCs and division/facility leadership
• Actively communicates with divisions, facilities and corporate stakeholders related to any credentialing issues or initiatives
• Works with SSD AVP Credentialing Shared Services to ensure any new policies / processes are compliant with all company / regulatory requirements
• Contributes to training and education materials for use in CPC training; presents training materials - as applicable
• Participates on corporate committees, work groups and task forces as needed
• Assures colleagues understand they may raise concerns or report suspected violations of the Code, of Policies and Procedures, or of law or regulations to a supervisor, to any member of local management, to the ECO, or to the Corporate Ethics Line without fear of retaliation  •  Maintains confidentiality with all payroll information 
• Sets appropriate example for staff by maintaining a positive attitude regarding customers, leadership, and the work at hand 
• Practice and adhere to the "Code of Conduct" philosophy and "Mission and Value Statement" 
• Other duties as assigned by the AVP

Job Requirements

• Bachelors degree required.
• Minimum 3 years experience in credentialing or data analysis
• Experience with hospital credentialing strongly preferred
- NAMSS certified CPCS level preferred