CVO Senior Credentials Manager

Description

Responsibilities:

• Directly manages CVO Credentialing Operations Supervisor/Manager and all credentials staff not reporting directly to the CVO Credentialing Operations Supervisor/Manager; includes workflow design, 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.
• Holds primary responsibility for CVO’s ongoing NCQA certification including but not limited to leading the biannual survey effort. Supports (Sr) Compliance Analyst with regulatory surveys/audits, and ensures compliance with TJC, DoH, CMS & NCQA standards.
• Manages and reports operational metrics. Monitors and manages turnaround times for processing of credentials applications and has overall accountability for focus on delivery of a high quality product, with the greatest efficiency, in the least amount of time. Accountabilities include but are not limited to:
• 1. Overall management of the application/verification and evaluation management in accordance with the procedures detailed in the CVO Operating Manual;
• 2. Coordinate with clients as they set up and credential new practices and providers;
• 3. Ensure expirables (licenses, DEAs, malpractice coverage, etc.) are kept current and ongoing monitoring is conducted, and status is reported to clients;
• 4. Identify and minimize data discrepancies passed to payer enrollment so that the data are complete, correct and timely in order to optimize the Revenue Cycle.
• Ensure compliance with accrediting organization requirements, each of the Penn Medicine medical staff bylaws & accompanying manuals and credentials-related policies, develop and review CVO Operating policies and procedures, and delegated credentialing policies and procedures; develops, recommends, and/or implements changes, revisions, and enhancements as appropriate.
• Responsible for maintaining strong customer relationships with client leaders and staff at Penn Medicine hospitals, ensuring that they understand their role in the credentialing process.
• Leads credentialing team in designing credentialing and privileging processes and in prioritizing and assigning resources devoted to process improvement, ensuring an appropriate level of quality control over credentialing and privileging work product.
• Supports the AVP in drafting the annual Office of Medical Affairs strategic plan/goals and budgets and proposes updates as necessary; manages strategic initiatives in order to keep on time and on budget, and provides AVP with regular updates.
  
• Works with OMA Managers to ensure that all CVO and hospital MSO staff have the necessary and appropriate training to be successful in their work.
• Serves as senior credentialing representative to clients, both within and outside of Penn Medicine.
• 1. Ensures that OMA is providing excellent service to its customers;
• 2. Primarily responsible for credentialing aspects of CVO integration projects;
• 3. Primary attendee of CVO Users Group and other operational meetings;
• 4. Primary credentialing participant in payer contract negotiation and contract implementation;
• Performs duties in accordance with Penn Medicine and entity values, policies, and procedures.
• Other duties as assigned to support the unit, department, entity, and health system organization.

Credentials:

• NAMSS certification (CPCS and/or CPMSM)- within one year of employment (Preferred).

Education or Equivalent Experience:

• Bachelor's degree, preferably in business, information management, health administration or related field (Required).
• 7+ years of experience with hospital credentialing and/or ‘delegated credentialing experience’ (Required).
• Master's degree, preferably in business, information management, health administration, or related field (Preferred).

Skills & Abilities:

• Must have the ability to maintain information in a confidential manner in accordance with all regulatory requirements.
• Must be able to think critically and generate/analyze information and instruct staff to do the same.
• Must be able to work effectively as a team leader, build effective teams, and drive employee engagement.
• Must be able to meet deadlines and conduct operations within budget.
• Must be able to exercise good judgment when escalating issues.
• Strong verbal and written communication skills to enable sufficient, timely, and effective communications with providers and external contacts.
• Proficient in computers and computer software, including but not limited to, database management, spreadsheet and word processing applications.
• Proficiency in Microsoft Office Suite.

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.