Credentialing Processing Center Manager in Nashville, TN at Parallon

Date Posted: 6/7/2018

Job Snapshot

Job Description

The Nashville Credentialing Processing Center (CPC) is looking for an experienced Credentialing Operations Manager to oversee the day to day operation of a large, high volume, multi-functional department that processes credentialing and recredentialing applications for medical providers. Functional areas of responsibility include correspondence, onlines, intake, and the outbound call unit, which includes supervising 2 team leads and 15 full time hourly employees. Candidates must have strong problem solving and technical skills with the ability to analyze complex data related to credentialing. The Operations Manager is responsible for ensuring that CPC projects, milestones, and department goals are met, along with reviewing and recommending process and system improvements to facilitate best practice operations. This position will collaborate with all levels of management across cross-functional departments. Must have excellent interpersonal and organizational skills, attention to detail, and be a team player. A Bachelor’s degree in Business Administration, Accounting, or a health care-related discipline required. Prior credentialing management experience preferred.

• Assist in planning, developing, implementing processes and documentation of processes as related to migration.
• Assist in establishing, reviewing, and implementing quality controls and reviews as related to operations.
• Assist in managing credentialing processes for multiple facilities.
• Provide input for process design and other implementation activities.

• Manage effective day-to-day operations of the credentialing functions through maintaining appropriate staffing levels and productivity to meet targeted service levels, turn around times, and satisfaction/quality levels.
• Provide leadership that creates and maintains effective and efficient credentialing processes that meet standards set forth by Joint Commission and Federal and State Regulations.
• Provide leadership and direction to maintain the integrity of the provider database for accurate display of information and accurate reports regarding credentialed providers.
• Provide leadership and direction for network reporting utilizing CACTUS software.
• Ensure high quality, timely and accurate credentialing processes and implement process standardization.
• Manage departmental Human Resources, including recruitment, hiring, process and application training, performance evaluations, coaching/counseling, and terminations.
• Support functions of CPC fiscal responsibility, including budget creation and management, A/R for application processing fees received, and A/P management including approve invoices/check requests to verification entities that do not accept American Express.
• Manage administration of HCA-selected credentialing and privileging software applications.
• Ensure CPC compliance with HCA facilities policy and procedures, state and federal regulatory entities (e.g. Joint Commission, CMS, AHCA) and participate/assist with facility audits/surveys.
• Provide status reports to Director, including candidate progress through request for information and consideration process.
• Provide advanced customer service for difficult clients/providers.
• Report regularly to CPC Director to confirm status of operations and compliance with all requirements as related to operations.

Job Requirements

• Organization – proactively prioritizes needs and effectively manages resources
• Communication – communicates clearly and concisely
• Leadership – guides individuals and groups toward desired outcomes, setting high performance standards and delivering leading quality services
• Customer orientation – establishes and maintains long-term customer relationships, building trust and respect by consistently meeting and exceeding expectations
• Tactical execution – oversees the development, deployment, and direction of complex programs and processes
• Policies & Procedures – articulates knowledge and understanding of organizational policies, procedures, and systems
• Financial management – applies tools and processes to successfully manage the budget
• Project Management – assesses work activities and allocates resources appropriately
• Credentialing & Privileging technical skills – extensive credentialing process and primary source verification knowledge

• BA/BS degree required.

• At least 2 years in credentialing management required. 
• Centralized credentialing/primary source verification office experience preferred. The successful candidate will have acquired these skills in the Human Resource Arena, Insurance Provider File or Credentialing Arena, or Practice Management Arena.
• Experience with Credentialing Accreditation by Joint Commission or National Committee for Quality Assurance preferred.
• Detailed working knowledge of the health care and credentialing industry, including medical-legal issues and laws, regulatory agencies, and other national standards preferred.

• NAMSS certified at CPMSM level preferred