AVP Medical Affairs and CVO

Description

Penn Medicine is dedicated to our tripartite mission of providing the highest level of care to patients, conducting innovative research, and educating future leaders in the field of medicine. Working for this leading academic medical center means collaboration with top clinical, technical and business professionals across all disciplines.

Today at Penn Medicine, someone will make a breakthrough. Someone will heal a heart, deliver hopeful news, and give comfort and reassurance. Our employees shape our future each day. Are you living your life's work?

Entity: Corporate Services

Location: Perelman Center for Advanced Medicine - 3400 Civic Center Blvd, Philadelphia, PA

Summary:

• Leads the Penn Medicine Credentials Verification Organization (CVO) for all Penn Medicine hospitals, contracted CVO clients and the Medical Staff Office (MSO) functions for the Hospital of the University of Pennsylvania (HUP), Pennsylvania Hospital (PAH) and Penn Presbyterian Medical Center (PPMC). Ensures setting and achievement of organizational goals, and operational quality and performance monitoring through established metrics.
  
  

Responsibilities:

Credentials Verification Organization

• Credentialing – Overall operational responsibility for the essential credentialing, recredentialing and clinical privileging processes for over 10,000 providers in accordance with relevant state(s) and federal law and department of health (DoH), The Joint Commission (TJC), National Committee on Quality Assurance (NCQA), and Centers for Medicare and Medicaid Services (CMS) standards/regulations. Scope include all Penn Medicine hospitals and provider-based outpatient site and ambulatory surgical facilities, as required.
• Payer Enrollment – Overall operational responsibility for the enrollment of approximately 6000 providers with approximately 75 payers, thereby directly and materially impacting the revenue cycle.
• Quality Improvement – Develops and ensures execution of, in concert with MSO and medical staff/administrative leadership from all Penn Medicine hospitals, a quality improvement plan for the credentialing and payer enrollment processes which promotes patient safety, minimizes professional liability risk, and maximizes revenue generation.
• Administration – Ensures:
• CVO contracts are in place with each hospital and contracted MSO
• Appropriate CVO policies and procedures are developed and maintained, approving any revisions
• Certification status is maintained from the National Committee on Quality Assurance (NCQA) in support of payer delegated credentialing agreements
• Budgets are developed and managed
• Contract and vendor relationship is maintained for Penn Medicine’s enterprise system for credentialing and payer enrollment.
• Stakeholder communication including but not limited to the CVO Users Group ensuring inclusion of membership from each of the Penn Medicine hospitals and the CVO Update, a broader group of application request submitters across Penn Medicine.
• Provider-specific credentialing and payer enrollment status information is available in a transparent manner to CVO clients.
  
  

HUP/PAH/PPMC Medical Staff Office

Administrative and medical staff regulatory support to the medical staff leadership including but not limited to:

• Ensures, working in close collaboration with the Medical Executive Committee (MEC) President/Medical Board (MB) Chair, that regular and ad hoc meetings are scheduled, agendas and minutes are generated and distributed, speakers and presentations are coordinated, and meetings run smoothly; ensures all presentations/actions required by regulation or law are made on a timely basis.
• Ensures MEC/MB nomination and election processes are conducted timely and in accordance with the entity medical staff bylaws.
• In collaboration with Office of General Counsel (OGC), supports the MEC/MB provider investigation process as described in the entity medical staff bylaws.
• In collaboration with OGC, draft updates to the medical staff bylaws for medical staff leadership review and approval Ensures Credentials Committee and reduced quorum MEC/MB meetings are scheduled and conducted at appropriate intervals to ensure timely provider credentialing/recredentialing.
• Coordinates the annual Faculty Onboarding process including:
• Leading educational meetings with department contacts and content experts in areas including but not limited to credentialing, enrollment, systems training and provisioning, occupational medicine, professional liability, marketing, and faculty affairs.
• Providing periodic provider onboarding status information to operational departments so they may fulfill their responsibilities.
• Clearing operational barriers by engaging appropriate leaders or content experts.
• Continuously improving onboarding processes and procedures both within OMA and among the coordinated operational departments.
• Regulatory – Support for hospital regulatory compliance functions including but not limited to participation in DoH and TJC surveys regarding medical staff standards.
  
  

Leadership – Fosters a work environment that:

• Promotes an understanding of the organization’s mission, vision and values within the department.
• Demonstrates the appreciation of all team members’ contributions to the success of the department.
• Affords staff the appropriate control on how they deliver defined results/outcomes (team empowerment, where appropriate).
• Promotes an open, two-way communication style within the work environment ensuring an exemplary level of professionalism and expected deliverables.
• Establishes a comprehensive level of trust within the work environment based on positive relationships, knowledge, and consistency.
• Provides staff the training they need to demonstrate and sustain success; ensuring their understanding of job expectations.
• Effectively communicates, to ensure staff understands deliverables and accountabilities.
• Develops and sustains a level of team collaboration and cooperation.
  
  

Information services/infrastructure – Ensures development and maintenance of processes for virtually paperless credentialing and payer enrollment functions, and ensures adequate vehicles and support for identification and resolution of improvements and problems.

Credentials:

Certified Provider Credentialing Specialist (CPCS) or Certified Professional Medical Services Management (CPMSM) as per the National Association Medical Staff Services (NAMSS) is required.

Education or Equivalent Experience:

• Bachelor's Degree is required.
• Master's Degree is preferred.
• 12 years experience in credentialing, payor enrollment or related field is required.
  
  

We believe that the best care for our patients starts with the best care for our employees. Our employee benefits programs help our employees get healthy and stay healthy. We offer a comprehensive compensation and benefits program that includes one of the finest prepaid tuition assistance programs in the region. Penn Medicine employees are actively engaged and committed to our mission. Together we will continue to make medical advances that help people live longer, healthier lives.

Live Your Life's Work

We are an Equal Opportunity and Affirmative Action employer. Candidates are considered for employment without regard to race, ethnicity, color, sex, sexual orientation, gender identity, religion, national origin, ancestry, age, disability, marital status, familial status, genetic information, domestic or sexual violence victim status, citizenship status, military status, status as a protected veteran or any other status protected by applicable law.