Credentialing Verification Office Manager

Position Details

Work Shift :

Day Shift (United States of America)

Scheduled Weekly Hours :

Department :

Medical Staff Services / Credentialing

Overview of Position :

Oversees the operations of the Genesis Healthcare System's Credentialing Verification Office (CVO) to develop, manage and monitor processes and procedures that support the credentialing, reappointment, expirable data management, and delegated credentialing contract processes. Ensures compliance with the appropriate accrediting and regulatory agencies. Supervises credentialing staff in the day-to-day management of the overall CVO credentialing process and database management.; Works with Hospital Administration and the Medical Staff Leadership in managing and coordinating credentialing administrative support and provides resources needed to fulfill their duties and obligations as defined by national regulatory agencies and the Medical Staff bylaws, rules and regulations as delegated by the hospital's Board of Directors.

ESSENTIAL DUTIES

Manages daily activities of Credentialing Verification Office (CVO). Uses data to drive decisions, plans and implements performance improvement strategies for CVO. Develops, administers, and manages the credentials verification and enrollment processes for the organization to assure all Medical Staff members are appropriately credentialed and privileged. Oversight of the Focused Professional Practice Evaluation (FPPE) and Ongoing Professional Practice Evaluation (OPPE) processes. Establishes policies, procedures, and systems to accomplish the credentials verification and enrollment process consistent with the organization’s credentialing protocols. Monitors and reports turnaround times for processing of credentials applications, with continued focus on delivery of a high-quality product, with the greatest efficiency, in the least amount of time. Participates in quality assessment and improvement activities, identifies opportunities to improve services, makes recommendations, and implements actions as appropriate and consistent with the goals of the organization. Develops annual plan, annual report, and overall strategic planning for the credentials department together with the Medical Staff Services Director and Chief Medical Affairs Officer (CMAO). Manages, assigns work, and trains staff to perform the work of the CVO. Directs and coordinates administrative support and provides resources needed for the medical staff to enable them to fulfill their duties and obligations as defined by federal regulatory agencies, bylaws and rules and regulations. Participates in department and hospital programs for quality assessment and improvement, identifies opportunities for improvement, makes recommendations, and implements actions that are consistent with the goals of the organization. Oversees the orientation program for new members of the medical staff. Provides support to the Director, CMAO and Medical Staff President by preparing and presenting regular and ad hoc reports for the board. Collaborates with the accreditation coordinator to assure compliance with medical staff standards. Keeps updated on HFAP and other accreditation standards. Develops and improves personal and departmental knowledge of computer software and reporting functions. Oversees a variety of projects and performs other functions as assigned.

QUALIFICATIONS

Bachelor’s Degree in business, hospital administration or related field. In lieu of Bachelors five (5) years of experience working in a CVO / Performance Improvement. Knowledge of credentialing techniques, standards, and principles. Knowledge on HFAP, NCQA, JCAHO, CMS, and other accreditation standards as they relate to credentials verification, enrollment, and medical staff operations. Strong analytical and organizational skills. The ability to effectively interact and relate to personnel at all levels of the organization. Knowledgeable of clinic and hospital services and personnel. Excellent interpersonal, decision-making, analytical facilitation, conflict resolution and investigative skills. Demonstrated excellence with listening, verbal, and written communication skills. Ability to work independently and under pressure in a complex and changing working environment. Excellent computer skills and knowledge of computer software, including programs such as Word, Excel, PowerPoint, etc.

PATIENT CENTERED CARE & BEHAVIORAL EXPECTATIONS

Living the Genesis Mission, Vision and Values

• Performs work in a manner that is quality focused.
• Treats patients, co-workers, visitors and volunteers with courtesy, compassion, empathy, and respect.
• Results oriented and focused on achievement of objectives.
• Acknowledges and responds to the diversity of people and the situation.
• Encourages peers (others) to be owners of change.
• Always makes the effort to anticipate and exceed customer needs and expectations.
• Possesses the ability to engage others with patience and understanding.
• Acts in a manner that creates positive first and lasting impressions.
• Demonstrates the ability to own issues until they are resolved.

Patient Centered Care (patients / families, physicians, co-workers, all other internal / external customers)

Promotes Patient and Employee Safety

WORKING CONDITIONS / PHYSICAL REQUIREMENTS

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential function of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Works in an office environment. Answers telephone calls, uses personal computer and other business machines extensively, which requires the ability to apply finger dexterity. Individual bends, reaches, pushes and pulls file drawers to file records and reports. Regularly lift or move up to 10 pounds, frequently lift or move up to 25 pounds and occasionally lift or move up to 50 pounds. Vision abilities required include up close vision, peripheral vision, depth perception and the ability to adjust focus.

Benefits include :