JOB SUMMARY

The Credentialing and Enrollment Director works closely with VP of Managed Care/Value Based Care, credentialing committee, physician review board, board of directors Physician Recruitment and Patient Financial Service to deliver timely credential verifications according to accreditation standards.
This role is critical in advancing our mission to “Make a difference, Every Day” and to provide support to the organizational key stakeholders. The Director provides strategic direction and oversight to credentialing staff (coordinators and specialists), payer enrollment staff and payor delegations. This Director, working within health system requirements, compliance with state and federal laws, CMS COPs, NCQA, Joint Commission and with the legal department, will also have responsibility to negotiate and maintain payor delegations, and outsourcing strategic planning and oversight for professional and facility credentialing and payor enrollment.
The Director is the administrative liaison between the medical staff representatives, hospital administration as mandated by the hospital’s Board of Directors, all system contracted payors for credentialing and enrollment and NCQA accreditation key contact for compliance with accreditation standards Leadership accountability will be expected in recognizing and implementing opportunities for improvement, monitoring performance of personnel, working effectively and collaboratively with the Director of Medical Staff Services and is expected to have working knowledge and ability to direct the resources of Medical Staff office if requested to do so on interim basis. Demonstrates ongoing growth and development of self through active self-reflection, personal competency development strategies, and role modeling the “Grow myself, grow my team, and grow Monument Health (G3) Leadership Competencies” to promote our Monument Health vision and mission.
Monument Health offers competitive wages and benefits on qualifying positions. Some of those benefits can include:
*Supportive work culture
*Medical, Vision and Dental Coverage
*Retirement Plans, Health Savings Account, and Flexible Spending Account
*Instant pay is available for qualifying positions
*Paid Time Off Accrual Bank
*Opportunities for growth and advancement
*Tuition assistance/reimbursement
*Excellent pay differentials on qualifying positions (extra pay for working evening, nights or weekends)
*Flexible scheduling

Responsible for developing processes that support the credentialing and enrollment personnel and their responsibilities as it relates to Joint Commission, CMS COPs and NCQA accreditation compliance, and the hospital’s mission and strategic plan. Components of this include but are not limited to:

• Directing and providing oversight to the credentialing, enrollment, and payor delegations.
• On a monthly basis track progress of initial applications, reappointments, changes in status and payor enrollment.
• Oversight knowledge of procedures and techniques that impact privilege and appointment processes.
• Leading Coordinators in maintaining, accurate credentialing materials processed by the department or outsourcing company, creating, maintaining and updating training materials and necessary documents.
• Maintain, create, and modify existing policies to maintain accreditation standards for NCQA.
• In partnership with the Director of Medical Staff Services assist in coordination, maintenance and review of two (2) sets of Bylaws and Governing Documents to ensure that all accreditation standards and Conditions of Participation are continuously met.
• Ongoing reporting and resolution efforts on enrollment denials, claims on hold and patterns in delayed payment to the key stakeholders including Chief Financial Officer, Patient Financial Services Leadership, and the VP of Managed Care.
• Coordinate and review all changes and reporting in Echo Credentialing Software or successor software.
• Direct oversight and planning of credentialing quality improvement projects as related to department specialists, coordinators and enrollment.
• Collaboration with Medical Staff Leadership which may include indirect oversight and cross functional leadership of one or more of the following:
• Administrative support to VPMA, Chief of Staff, Department and Committee chairs and other Medical Staff Leaders.
• Support tasks assigned by the MECs and or Presidents of the Medical Staff.
• In collaboration with the VPMA, serves as liaison between the Medical Staff, credentialing contracts for independent community providers and Hospital(s).
• Timely response to key stakeholder issues, facilitation of teamwork, and communication and issue resolution.
• Create and implement improvements to process workflows.
• Recruit, select, assist with training, and manage staff.
• Provide regular performance evaluations and educational opportunities for members of the department to promote professional growth.
• Coordinate all projects related to provider & facility enrollment, credentialing and accreditation standards (ie. location changes, new services lines, delegation of credentialing, accreditation support for new and existing programs).
• Remains agile and flexible while identifying and anticipating future trends/opportunities.
• Fosters an environment of innovation, creation and implementation of new services and sustainability.
• All other duties as assigned