Corporate Director of Credentialing
Location: Chesterfield
Posted on: November 14, 2024
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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.
Keywords: , St. Louis , Corporate Director of Credentialing, Professions , Chesterfield, Missouri
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