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Manager, Credentialing Ops & Provider Network Quality
Manager, Credentialing Ops & Provider Network Quality
JOB SUMMARY: This position develops and manages the Company s (PHCS and MultiPlan), Beech network and HEOS Credentialing and Recredentialing Programs to meet corporate and regulatory requirements and accreditation goals. Provide leadership, direction and back up support to staff responsible for functional activities related to initial credentialing and recredentialing of the MultiPlan, PHCS and HEOS Provider Networks.
JOB ROLES AND RESPONSIBILITIES:
1. Ensure all (re)credentialing processes are in compliance with NCQA and URAC accreditation standards in an effort to maintain accreditation by effectively and efficiently managing and directing all department activities and ensuring that all supporting applications meet business objectives.
* Design operational processes cycle in support of staff, time and quality objectives for (re)credentialing to meet NCQA and URAC requirements and additionally in support of all MultiPlan and HEOS networks. Continually search for ways to streamline and/or reduce (re)credentialing costs.
* Perform internal, external and compliance audits on credentialing activities and external vendors to assess efficiency, production, quality, data integrity and regulatory compliance. Share and publish data as required.
* Manage recredentialing of non-respondent and reinstatement and approval processes for non-standard contract language in collaboration with appropriate individuals and departments.
3. Quality Management - Collaborate with management to identify, develop and support quality and training improvements. Represent department and act as liaison on the Quality Management Committee.
4. Policy Management Develop, implement, maintain and assure compliance of staff for all applicable policies and procedures.
5. Reporting & Data Integrity Develop and implement reporting for metrics for production, quality, compliance, system effectiveness, cycle time and staff productivity auditing for data integrity and coordinating results with management for departmental reporting.
6. System Support Act as business owner for assigned systems providing direction, support and cross training for smooth operations identifying issues and recommending system solutions as appropriate. Act as liaison with appropriate departments
7. Training Manage, identify and oversee ongoing training needs for departmental staff including the delivery of NCQA and URAC related training to internal and external customers.
8. Project Management Identify, collaborate and manage projects according to the needs of the department and in support of corporate objectives acting as a subject matter expert (SME) for (re)credentialing operation information, processes and procedures.
9. External Review Provide support, direction and coordination of audit functions and customer review of credentialing functions through onsite and online activities. Identify deficiencies and corrective action plans as required coordinating activities to bring identified issues into compliance.
10. Select, develop, and evaluate staff to ensure the efficient operation of department.
11. Ensure systematic data oriented efforts to improve consumer and/or client services. Seventy (70%) percent of this job is related to QM activities.
12. Collaborate, coordinate, and communicate across disciplines and departments.
13. Ensure compliance with HIPAA regulations and requirements.
14. Demonstrate Company s Competencies and Core values held within.
15. The position responsibilities outlined above are in no way to be construed as all encompassing. Other duties, responsibilities, and qualifications may be required and/or assigned as necessary.
This position manages department processes and is considered to be a fully competent professional who knows and applies a broad knowledge of principles, practices and procedures. Incumbent works under limited supervision with independence and general latitude to make commitments with occasional need to confer at a higher level. Incumbent understands when to escalate issue to higher level and ensures that decisions consider the full implications (business, legal and competitive) to both the organization and customer. This is a management position overseeing a staff of direct and indirect reports. Responsibilities may include some budgetary functions. Seventy (70%) percent of overall responsibilities are dedicated to Quality Management (QM) functions which consist of a seat on the QM Committee and collaborating with management to identify, develop and support quality and training improvements.
JOB REQUIREMENTS (Education, Experience, and Training):
* Minimum Bachelor s degree , or HS Diploma and 4 years of related experience
* Minimum 5 years of experience in related managed healthcare environment including minimum 3 years of project management and supervisory experience
* Required licensures, professional certifications, and/or Board certifications as applicable
* Active or actively pursuing Certified Provider Credentialing Specialist (CPCS) certification
* Knowledge of accreditation standards related to NCQA, URAC and state regulatory agencies
* Knowledge of the Company s data systems and a familiarity with Imaging/Workflow Environment; ECHO database systems; Provider Data Management processes (Registrar, Cred/ReCred, Demographics, rates) and Service Operations desirable.
* Knowledge of departmental processes and its relationship with organizational objectives and outcomes.
* Communication (oral, written and listening), prioritization, organizational, project and process management, leadership and team building skills
* Ability to lead, motivate and mentor individuals and teams
* Ability to serve as a subject matter expert (SME) on regulatory compliance and credentialing requirements
* Ability to negotiate and coordinate activities of individuals and groups
* Ability to effectively manage resources and workflow for multiple projects simultaneously
* Ability to use software, hardware and peripherals related to job responsibilities including MS Office
* Ability to manage operations in a high volume, date driven environment
* Ability to translate business vision and strategy into project requirements
* Ability to work with and understand complex data systems
* Ability to keep the needs of external and internal customers a priority when making decisions and taking action
* Ability to focus on results and successful achievement of business objectives
* Ability to take action independently by gathering information, identifying tasks and following through
* Ability to collaborate with others to ensure best practices are explored, implemented and shared
* Ability to develop and maintain cooperative relationships at all levels of organization by sharing information
Diversity and Equal Employment Opportunity (EEO)
As an Equal Opportunity Employer, Viant will provide equal consideration to all colleagues and job candidates without regard to sex, age, race, marital status, sexual orientation, religion, national origin, citizenship status, physical or mental disability, political affiliation, service in the Armed Forces of the United States, or any other characteristic protected by federal, state, or local law.
We offer a competitive total compensation and benefits package, an incentive bonus program and an employee recognition program that acknowledges and rewards employees for outstanding performance. Here's a summary of the benefits we offer to MultiPlan employees.
•Medical Dental & Vision Insurance
•Optional and Dependent Life Insurance
•Short and Long-Term Disability
•Paid Time Off
•Paid Company Holidays
•Flexible Spending Account