Overview: CommonSpirit Health was formed by the alignment of
Catholic Health Initiatives (CHI) and Dignity Health. With more
than 700 care sites across the U. S. , from clinics and hospitals
to home-based care and virtual care services, CommonSpirit is
accessible to nearly one out of every four U.S. residents. Our
world needs compassion like never before. Our communities need
caring and our families need protection. With our combined
resources, CommonSpirit is committed to building healthy
communities, advocating for those who are poor and vulnerable, and
innovating how and where healing can happen, both inside our
hospitals and out in the community.
Responsibilities Job Summary: Provides oversight and support to
the PHSO Credentials Verification Organization (CVO). Responsible
for all primary source verification activities to ensure that
processes meet state, federal, and NCQA Accreditation standards.
Serves as a liaison between PHSO administration, Chapters, Medical
Staff offices and other clients, MercyOne Partnered Provider
organizations and their clinicians to introduce and institute
Essential Position Expectations:
Governance & Compliance
Under the direction of the Provider Network Council, develops
and maintains an NCQA-compliant CVO and all related policies and
procedures; and serves as the subject matter expert in
Promotes credentialing staff compliance with regulatory and
accreditation agencies by continuously monitoring the operations of
the CVO and effectively initiating organizational/system change
when needed or required.
Represents the CVO in all payer, governmental, and NCQA audits
and accreditations, and leads successful completion of such audits
Develops quarterly CVO reports for the PHSO Board of Managers
and monthly CVO reports for the Provider Network Council.
Responsible for all client relationship management, including
payers, representing the CVO in all client relationships and
ensuring timely follow-up to client feedback.
Recruits new clients to support CVO revenue and ensures
competitive rate setting/fee schedules in collaboration with Payer
Perform client and clinician education; must be available to
guide clinicians through the online application process and clearly
In collaboration with the credentialing, enrollment, and medical
staff team, ensures appropriate information is captured and
reportable through the credentialing system and ensures reporting
meets all stakeholder needs.
Applies principles of continuous quality improvement in delivery
of services, through assessment and monitoring of provider files,
processes, and database systems.
Overall management of the CVO functions including budgeting,
resources, and team development.
Responsible for provisioning new access to systems and issue
resolution regarding database access.
Knowledge & Skills:
Experience in PHSOs or ACOs and knowledge of value-based payment
structures is preferred.
Demonstrated proficiency in Microsoft applications required.
Strong demonstrated verbal communication and critical thinking
Demonstrated presentation skills.
Excellent verbal and writing skills required, as well as
excellent planning and negotiating skills.
Excellent project management skills.
Demonstrated ability in policy development.
Demonstrated proficiency in credentialing software and
CommonSpirit Health is an Equal Opportunity employer committed
to a diverse and inclusive workforce. All qualified applicants will
be considered for employment without regard to race, color,
religion, sex, sexual orientation, gender identity, national
origin, age, disability, marital status, parental status, ancestry,
veteran status, genetic information, or any other characteristic
protected by law.
External hires must pass a post offer, pre-employment background
check/drug screen. Qualified applicants with an arrest and/or
conviction will be considered for employment in a manner consistent
with federal and state laws, as well as applicable local
ordinances, ban the box laws, including but not limited to the San
Francisco and Los Angeles Fair Chance Ordinances.
If you need a reasonable accommodation for any part of the
employment process, please contact us by telephone at (415)
438-5575 and let us know the nature of your request. We will only
respond to messages left that involve a request for a reasonable
accommodation in the application process. We will accommodate the
needs of any qualified candidate who requests a reasonable
accommodation under the Americans with Disabilities Act (ADA).
CommonSpirit Health participates in E-verify.