Manages the daily operations, functions, and staff of the credentialing team. Provides direct supervision and coordination of the credentialing and re-credentialing process and delegated credentialing groups to ensure compliance with organizational policies and procedures, industry standards, state and federal regulations, and NCQA requirements.
ESSENTIAL FUNCTIONS OF THE ROLE
Manages the hiring, supervision, performance management, and discipline functions for the credentialing team.
Oversees departmental orientation, training and development of staff, and ensures ongoing staff skills.
Conducts regular meetings with employees to ensure open and constructive communication.
Reviews daily operations, including providing work assignments, continuous problem-solving, and prioritization.
Works closely with staff to maximize operational efficiencies.
Manages the vendor relationship with the company that performs the primary source verification for all contracted physicians.
Assists in keeping the department within budget by seeking avenues for cost containment for credentialing functions.
Develops and implements policies, procedures, and processes for the department that satisfy the business needs of the organization while adhering to applicable standards, regulations, and requirements.
Serves as the subject matter professional for regulatory requirements, measures, and standards as they relate to credentialing.
Manages the daily activities of the credentialing and re-credentialing of medical staff and allied health professionals (ie. Entry of provider demographic data into the credentialing database; review of required licenses, certifications, and/or malpractice insurance; verification that provider has not been sanctioned by OIG or CMS; etc).
Manages delegated credentialing groups and ensures that each group has a signed delegated agreement and that all delegated tasks are completed.
Coordinates and supervises credentialing audits and on-site reviews.
Coordinates and attends all Credentialing Committee Meetings.
Accountable for the accuracy and integrity of the data entered and stored within the credentialing database.
Develops and maintains reports from the database for both internal and external requirements, as needed.
Establishes and maintains courteous and effective relationships with internal and external customers.
Performs other position-appropriate duties as required in a competent, professional and courteous manner.
KEY SUCCESS FACTORS
Proficient in Microsoft Office Suite (Outlook, Excel, Word, PowerPoint).
Excellent written and verbal communication skills.
Proven ability to effectively communicate with internal and external customers at various levels.
In-depth knowledge of NCQA standards regarding medical staff and allied health professionals credentialing.
Experience in managed care and credentialing of medical staff and allied health professionals.
Our competitive benefits package includes the following
Immediate eligibility for health and welfare benefits
401(k) savings plan with dollar-for-dollar match up to 5%
PTO accrual beginning Day 1
Note: Benefits may vary based upon position type and/or level
Baylor Scott & White Health (BSWH) is the largest not-for-profit health care system in Texas and one of the largest in the United States. With a commitment to and a track record of innovation, collaboration, integrity and compassion for the patient, BSWH stands to be one of the nation’s exemplary health care organizations. Our mission is to serve all people by providing personalized health and wellness through exemplary care, education and research as a Christian ministry of healing. Joining our team is not just accepting a job, it’s accepting a calling!