Director, Credentials Verification Office

Location: Burlington, MA
Job ID: 156368-1A
Date Posted: Oct 2, 2019

Job Description

About the Job

Position Summary:
The Director, Credentials Verification Office (CVO) oversees the operations of the CVO to develop, manage and monitor processes and procedures that support the credentialing, re-credentialing, expirables data management, and delegated credentialing contract processes. Oversees all of the credentialing functions, including application
management and primary source verification for Beth Israel Lahey Health (BILH). Ensures compliance with the appropriate accrediting and regulatory agencies. Supervises credentialing staff in the day-to-day management of the overall CVO process and database management. Although not directly responsible for entity-level medical staff
functions, the Director will work with medical staff offices to provide guidance and, where appropriate, promote alignment for credentialing, privileging and, more generally, medical staff policies and processes.


Essential Duties & Responsibilities including but not limited to:

  • Supports the organization’s mission, vision and values.
  • Directs, oversees, and implements the credentialing verification process for all licensed providers in accordance with The Joint Commission (TJC) and Commission on Medicare and Medicaid Services (CMS) accreditation standards, Federal and State laws, system policies and medical staff bylaws.
  • Ensures efficient and effective workflows
  • Coordinates the management of the credentialing database and associated modules, ensuring accuracy of data and reporting to downstream systems. Monitors critical data for extensive analysis and report generation.
  • Coordinates the development and management of the electronic credentials application to ensure distribution, receipt, processing, and timely delivery to local medical staff offices and other entities requiring the information.
  • Coordinates the management of the expirables process to ensure that all contracted provider licenses and certificates remain current, ensuring appropriate notification prior to expiration.
  • Develops short and long-term goals and measures for CVO performance and is accountable for ensuring that performance is improved to reach these goals.
  • Directs the CVO quality improvement program including analysis of entity-level feedback and aggregate data, identification of opportunities for improvement and implementation of appropriate interventions to address opportunities and ensure that standards are met.
  • Monitors compliance with state, federal and regulatory requirements and develops strategies to ensure optimal functioning of the department and compliance with all.
  • Is a resource to entities regarding credentialing practices and services; prepares and conducts credentialing orientations and provides updates, about new policies and procedures, as appropriate.
  • Works collaboratively with Medical Staff Offices, employed providers and independent providers. Serves as a resource to Medical Staff Offices, administration, medical staff leadership, staff and other hospital personnel, and ensures credentialing operations meet hospital, governmental and regulatory agency standards.
  • Provides consultation and education to medical staff offices regarding credentialing requirements.
  • Functions as the primary CVO contact for all internal and external inquiries; coordinates with the entity-level Medical Staff Offices to respond to these inquiries.
  • Prepares for and coordinates credentialing audits in compliance with the managed care delegated credentialing contracts, when applicable.
  • Directly supervises system-level personnel supporting the CVO, which includes hiring, work allocation, training, promotion, enforcement of internal procedures and controls, and problem resolution; evaluates performance and makes recommendations for personnel actions; motivates employees to achieve peak productivity and performance.
  • To support the development and maintenance of the provider directory, develops and maintains standardized data integrity rules guided by the organization’s data governance process.
  • Develops, implements and monitors the operating budget for the department. The Director is accountable for all budgetary matters, including variances. Frequently assesses the productivity of the department and develops business plans to ensure effective business operations.
  • At the appropriate time, leads the process of attaining NCQA certification.
  • Handles with discretion issues that are significant, complex, multidisciplinary, sensitive, and confidential. As a liaison between the system leadership and external constituents, as well as, between system and entity-level leadership, exercises best judgment and decision-making while providing effective and appropriate leadership to staff.
  • Creates a culture of engaged colleagues through promotion of BILH guiding principles and the development, mentorship and creation of a positive service-oriented work culture. Develops and maintains positive working relationships.
  • Participates in system integration and continuing quality improvement efforts in relation to work under his/her purview.

Minimum Qualifications:

Education: Bachelor's degree in Health Care Administration, Business Management or related field. Master’s preferred.

Licensure, Certification & Registration: NAMSS-sponsored CPMSM and CPCS certification.

Experience:

  •  3-5 years’ experience in Hospital administration at the executive level.
  • 5-7 years directing Medical Staff Services in an academic medical center and/or complex health system.
  • Previous CVO experience is required.
  • Experience in a multi-facility setting preferred.

Skills, Knowledge & Abilities:

  • Analytical skills necessary to resolve problems requiring a professional level of knowledge in a specific discipline/field and/or improve enhance or upgrade complex clinical, financial, data processing, Marketing or Human Resources systems and programs.
  • Knowledge of ECHO, Cactus or other credentialing software and associated applications preferred.
  • Ability to effectively manage the employees within assigned unit/department and to persuade and negotiate with peer level managers on issues and programs that impact assigned unit/department. Work requires effectively dealing with conflicting views or issues and mediating fair and workable solutions.
  • Strong leadership and supervisory skills required.
  • Strong analytical and database management skills.
  • Excellent organizational skills with demonstrated ability to execute projects on time.
  • Knowledge of regulatory, licensing and accreditation requirements.
  • Advanced skills with Microsoft applications which may include Outlook, Word, Excel, PowerPoint or Access and other web-based applications. May produce complex documents, perform analysis and maintain databases.
  • Ability to work independently and with minimal supervision.
  • Excellent interpersonal, verbal and written skills required.
  • Extensive knowledge of the operations of medical staff offices, including familiarity with medical staff policies, regulations, by-laws and the legal environment within which they operate.