Corporate Director of Credentialing

Location: Chesterfield
Posted on: November 14, 2024

Job Description:

? A Fortune 500/300 Company is looking for a seasoned professional with strong background in credentialing/regulatory affairs or related experience. Our ideal candidate is a critical thinker, can accurately assess risks and make corporate wide recommendations for process improvements aimed at improving both our production and our quality.?

Position Purpose: Oversee the day to day operations of the credentialing of providers for corporate and market managed health plans

? Oversee the credentialing and re-credentialing activities of all physicians, mid-level practitioners and organizational providers according to plan specifications for multiple business units

? Ensure compliance with NCQA as well as other regulatory bodies related to credentialing and re-credentialing requirements

? Develop and implement enterprise wide strategies that ensure adherence to those regulatory requirements

? Support all the Health plans with their NCQA accreditation efforts and with all related audits and continuously monitoring of credentialing and re-credentialing activities

? Develop and Oversee the implementation of quality monitoring practices/programs that support every day operations and growth

? Collaborate with the health plans and other departments on network expansion efforts

? Identify process improvement opportunities to decrease cost, improve quality and increase efficiency within the credentialing departments throughout the enterprise

? Oversee the development and review of policies and procedures, work processes, standard operating procedures, reporting needs and other tools that ensure production management and standardization across the enterprise

? Monitor Medicaid and Medicare sanctioning reports to ensure compliance with Health Care Financing Administration (HCFA) requirements regarding prohibition of excluded provider participation

? Facilitate Credentialing Committee activities and serve on Quality Improvement Committees, as needed

? Assist system integration by providing input, testing and process improvement recommendations for changes and new design within core application system

Qualifications

Education/Experience: Bachelor's degree in Business, Healthcare Administration, related field or equivalent experience. 7+ years of combined management, credentialing or regulatory affairs experience, preferably in a managed care or insurance environment. Experience with and knowledge of NCQA and credentialing processes. Strong previous management experience including responsibilities for quality and production oversight.

We are an equal employment opportunity employer and will consider all qualified candidates without regard to disability or protected veteran status.

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