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Credentialing Manager

Company: MercyOne Des Moines Medical Center
Location: Des Moines
Posted on: November 22, 2020

Job Description:

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 Network standards.

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 Credentialing Standards.

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 and accreditations.

Develops quarterly CVO reports for the PHSO Board of Managers and monthly CVO reports for the Provider Network Council.

Client Services

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 Strategies.

Perform client and clinician education; must be available to guide clinicians through the online application process and clearly communicate requirements.

Process Improvement

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.

Management

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.

#MissionCritical

Qualifications

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 skills required.

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 enrollment reports.

Equal Opportunity

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.

Keywords: MercyOne Des Moines Medical Center, Des Moines , Credentialing Manager, Other , Des Moines, Iowa

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