Mgr- Credentialing

at Northern Light Health in Brewer, Maine, United States

Job Description

The compensation range listed reflects the range Northern Light Health anticipates relying on in setting the wages for the position. The range may not necessarily include all additional compensation elements available, such as differentials, incentive programs and benefits.

Northern Light Health

Department: Credentialing

Position is located: Cianchette Professional Blding

Work Type: Full Time

Hours Per Week: 40.00

Work Schedule: 8:00 AM to 4:30 PM

Summary:

This position will provide best practice administrative management services for all aspects of credentialing verifications performed on behalf of Northern Light Health. Leadership accountability will be expected in managing credentialing operations and activities by demonstrating current practices and by using and integrating technology. The Manager will be responsible for developing systems that support their organization’s mission and strategic plan. A key performance area will be regulatory and accreditation knowledge and compliance.

Responsibilities:

Program Management

Plans, implements, organizes and oversees a comprehensive credentialing verification program

+ Assists in developing, influencing and implementing system design and credentialing workflows.

+ Leads a comprehensive and technologically driven verification process to ensure continuity, accuracy, completeness and timeliness.

+ Protects the integrity and security of the database.

Designs and directs the use of process and performance improvement data to implement change

+ Collaborates with key staff and clients on managing an ongoing reporting process that is accurate, timely and action driven.

Controls the administrative support of operating documents

+ Ensures that all documents are compliant and current.

+ Protects permanent records by managing a secure record retention process.

Plans and manages strategic and daily activities of the department

+ Responsible for adequate staffing.

+ Collaborates, develops and implements long and short-term goals.

+ Establishes standards and analyzes workflows that promote best practices and champions innovation.

+ Manages team to align with departmental budget.

Plans and manages an effective meeting management system

+ Leads meeting activities (agenda development, documentation, follow-up and communication).

+ Provides guidance on accreditation, regulatory issues, national standards, best practices, meeting outcomes and resolution.

Collaboration

+ Serves as a liaison between the credentialing team and Medical Staff Offices.

+ Influences and leads technology integration and migration with other information systems.

+ Manages requests to generate customized reports, perform additional verifications and provide added services.

Regulatory & Quality Compliance

+ Interprets, develops and implements practices of all systems and functions to ensure continuous compliance with regulatory agencies and accrediting body standards [CMS, JC, NCQA, AOA-HFAP, AAAHC, URAC, etc.].

+ Manages client audits, findings and reports.

+ Participates on compliance teams and in regulatory and accreditation surveys.

+ Seeks and maintains departmental certifications.

+ Develops and oversees operational quality indicators which reflect meaningful measures of quality of services provided. These indicators are monitored on a scheduled basis and corrective action is instituted, when required.

+ Assure that workflow, information systems and policies and procedures are current and appropriately maintained.

Leadership

+ Supports education, professionalism, practice-based learning and systems-based learning.

+ Responsible for recruiting, training, mentoring, evaluating and disciplining staff.

+ Cultivates positive interpersonal relationships with clients, medical services professionals, practitioners, ancillary staff and senior management.

+ Promotes ongoing education.

Other Related Functions

+ Assure that human resources are managed in accordance with organizational policies and procedures.

+ Establishes work standards; promote best practice by continually assessing credentialing and privileging processes and championing innovation and best practice.

+ Provides ongoing communication with relevant medical staff leaders and hospital administration.

+ Assist with delegated agreements, including credentialing audits.

+ Other Duties

Other Information:

+ Certified Provider Credentialing Specialist (CPCS) or Certified Professional Medical Services Management (CPMSM) required, or achievement of certification as determined by leadership.

Competencies and Skills

+ Achieves Results: Sets high standards for their own outcomes and seizes opportunities to engage others towards objectives. Consistently moves forward with direct actions in order to attain or exceed objectives. Manages their own time effectively to accomplish assigned tasks. Successfully prioritizes multiple projects and duties as needed.

+ Acts Strategically: Creates effective plans that anticipate future consequences and opportunities and is able to connect the day to day operations to longer-term objectives, shifts in the industry, and system goals.

+ Adobe Acrobat

+ Applies Business Acumen:Demonstrates knowledge of current and future trends that impact organizational success. Applies proven practices and business theories to get results that meet financial as well as other business goals. Recognizes opportunities for new services and products and acts accordingly, taking measured risks into consideration. Possesses a thorough knowledge of their field and independently carries out their work in accordance with professional standards of the profession.

+ Demonstrates Adaptability: Learns quickly when facing a new problem or unfamiliar task; is flexible in their approach with changing priorities and ambiguity. Manages change effectively and does not give up during adversity. Capable of changing one’s behavioral style and/or views in order to attain a goal. Absorbs new information readily and puts it into practice effectively.

+ Demonstrates Emotional Intelligence: Exhibits a high level of self-awareness, self-management, other awareness and relationship management. Conducts themselves in an empathic, appropriate way, with a sense of humor and stimulates a collaborative work environment. Is respectful of the attitudes, feelings, or circumstances of others and aware of the influence of their own behavior on them. Is aware of relevant social, political, system, and professional trends and developments and uses this information for the organization’s benefit.

+ Develops Self and Others:Takes responsibility for engaging in professional self-development activities and programs. Strives to gain insight into their own values, strengths and weaknesses, interests and ambitions and takes action in order to enhance competencies and skills when possible. As a leader, encourages and guides employees towards growth opportunities to enhance performance and help them reach goals. Reviews and analyzes employees’ strengths and weaknesses to distinguish their talents and development needs, and to ensure they are enhanced appropriately.

+ Effectively Communicates: Listens, speaks and writes appropriately, using clear language. Communication methods are fitting to the message(s), audience, and situation and follow-ups are regular and timely. Shows that important (non-) verbal information is absorbed and understood and asks further questions to clarify when necessary. Expresses ideas and views clearly to others and has ability to adjust use of language to the audiences’ level.

+ Exercises Sound Judgment & Decision Making: Understands and processes complex information, which allows for appropriate and accountable conclusions. Does not react too quickly or slowly. Balances facts, goals, and potential ap