What are the responsibilities and job description for the Director of Credentialing position at SENTA Partners?
Southern Ear, Nose, Throat and Allergy (SENTA) physicians provide the highest quality allergy, asthma, immunology and otolaryngology care through our network of practices.
SENTA is a leading Management Services Organization (MSO) specializing in providing comprehensive support to ENT and Allergy private practices. Our mission is to help people Breathe better, Hear better, Live better. At SENTA, we focus on the operational efficiencies and financial performance of our partner practices, allowing physicians to focus on delivering exceptional patient care. We are committed to fostering a collaborative and supportive work environment where our employees can thrive and grow.
We offer:
- Competitive salary
- Comprehensive health, dental, and vision insurance
- Paid time off and holidays
- Retirement savings plan with company match
- Supportive and collaborative work environment
POSITION OVERVIEW
The Credentialing Director is responsible for overseeing and managing the credentialing and re-credentialing process for healthcare providers within our organization. Significant focus of the role will be on streamlining processes, setting up Credentialing software to optimize the credentialing flows, producing reports and other analytical data points for continuous improvement of operational performance. units.
Team Leadership
- Manage staff, including hiring qualified candidates, career development, training, monitoring productivity and accuracy, and conducting performance evaluations
- Provide mentorship and professional development opportunities for team members
Credentialing Process Management and use of Technology:
- Maximize the capabilities of the current credentialing software, develop workflows, use of forms and full understanding the system’s functionality
- Design and rollout the credentialing processes for healthcare providers, ensuring compliance with industry standards and regulatory requirements
- Maintain accurate and up-to-date provider credentialing data in the credentialing database
- Generate reports and analytics related to provider credentialing for internal and external stakeholders
- Utilize data analytics to monitor performance metrics and make informed decisions
Quality Assurance:
- Implement quality assurance measures to ensure the accuracy and completeness of provider credentialing electronic files
- Conduct regular audits to identify and address any discrepancies or issues in the credentialing process
- Utilize data analytics to monitor performance metrics and make informed decisions
- Ensure compliance with all federal, state, and local regulations related to credentialing and payor enrollment
Collaboration with Stakeholders:
- Work closely with internal departments, including operations, contracting, revenue cycle to ensure alignment in credentialing processes
- Collaborate with internal departments to streamline processes and improve communication regarding clinician credentialing
- Resolve the most complex problems related to credentialing
- Facilitate resolution or provider related denials to ensure appeal procedures are followed to result in proper reimbursement
EDUCATION AND EXPERIENCE
- Bachelor’s degree desired
- 5 years of experience in clinician credentialing and payor enrollment within a healthcare setting
- Experience managing and developing credentialing software
- Experience working with institutions that have various accrediting bodies such as Joint Commission, Clinically Integrated Networks (CIN), etc.
- Strong track record of leading process improvement initiatives within a credentialing environment
