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Summary:

Oversees the operations of the CHP to develop, manage, and monitor processes and procedures that support the credentialing, re-credentialing, expireables, and delegated credentialing processes. Oversees all of the credentialing functions including application management and primary source verification. Ensures compliance with the appropriate accrediting and regulatory agencies. Supervises credentialing staff in the day-to-day management of the overall CHP credentialing process and database management.

· Directs the CHP credentialing process for all managed care and medical staff providers, in accordance with The Joint Commission, NCQA, URAC, and CMS accreditation standards, Federal and State Laws, and CHRISTUS Health policies.

· Coordinates the management of the credentialing database and associated applications, ensuring accuracy of data and reporting to downstream systems. Monitors data for analysis and report generation.

· Coordinates the management of the application process, to ensure distribution, receipt, processing, and timely delivery to clients

· Directs the management of the expireables process to ensure all provider licenses, insurance, and certifications remain current, ensuring appropriate notification prior to expiration.

· Monitors and reports turnaround times for processing of applications, with focus on delivery of a high-quality product with the greatest efficiency.

· Participates in development and review of CHP operating policies and procedures; develops, recommends, and/or implements changes, revisions, and enhancements as appropriate to current operating environment.

· Analyzes accreditation standards and develops criteria to ensure compliance.

· Prepares for and coordinates credentialing audits in compliance with accrediting agencies and managed care contracts.

· Functions as the primary CHP credentials contact; develops and maintains positive working relationships across ministries.

· Oversees the supervision of associates, which includes training, promotion, enforcement and auditing of internal procedures, and problem resolution; evaluates performance and makes recommendations for personnel actions; motivates associates to achieve peak productivity and performance

· Performs miscellaneous job-related duties as assigned.

Requirements:

Work Type:

Full Time

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About CHRISTUS Health

CHRISTUS HEALTH is an international Catholic, faith-based, not-for-profit health system comprised of almost more than 600 services and facilities, including more than 60 hospitals and long-term care facilities, 350 clinics and outpatient centers, and dozens of other health ministries and ventures. CHRISTUS operates in 6 U.S. states, Colombia, Chile and 6 states in Mexico. To support our health care ministry, CHRISTUS Health employs approximately 45,000 Associates and has more than 15,000 physicians on medical staffs who provide care and support for patients. CHRISTUS Health is listed among the top ten largest Catholic health systems in the United States.

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https://careers.amcp.org/jobs/18310578/director-credentialing