Director Credentialing

Director Credentialing

Are you looking for a rewarding career with family-friendly hours and top-notch benefits? We're looking for qualified candidates like you to join our Texas Health family.

• Work location: Texas Health Physicians Group

• Core work hours: Full Time (40 Hours); Day Shift 8:00a-5:00p This is a remote work opportunity

Texas Health Physicians Group includes more than 1,000 physicians, nurse practitioners and physician assistants dedicated to providing quality, patient-safe care at more than 240 offices located throughout the DFW Metroplex.

THPG members are active in group governance and serve on multiple committees and councils. Ongoing Texas Health initiatives, like the Diversity Action Council and Living the Promise have helped create an inclusive, supportive, people-first, excellence-driven culture and workplace, making THPG a great place to work.

Position Summary

Responsible for developing and maintaining a high quality, comprehensive credentialing and provider enrollment program supporting the institution's mission, values, and strategic plan for Texas Health Physicians Group.

This position has the oversight for the implementation of successful programs for credentialing, privileging, policy management, legal and regulatory compliance, adverse action support and workflow processes for on time processing of applications. Monitor all applicable regulatory laws and statutes (state and federal) and accreditation standards. These include, but are not limited to, system compliance with State, CMS, NCQA, URAC, and Joint Commission requirements. The Director, Credentialing has overall responsibility of the daily operations of the credentialing department to include financial accountability, management development, human resources issues, and customer service strategies. This position also supports credentialing and enrollment for various system initiatives.

Job Description

Oversee Credentialing Processes

Manage and ensure the efficient and accurate credentialing of all healthcare providers within the system.

Develop and implement credentialing policies and procedures in accordance with regulatory and accreditation standards.

Identify potential risks related to credentialing and develop strategies to mitigate these risks.

Ensure timely resolution of any credentialing discrepancies or issues that could impact patient safety or organizational compliance.

Lead the oversight of all delegated activities to ensure compliance with CMS, and NCQA requirements.

Prepare and present files at the credentialing committee meetings.

Create and manage the credentialing committee roster and calendar.

Act as a resource and liaison for the credentialing committee to ensure equitable credentialing decisions and confidentiality.

Process committee stipends as needed.

Facilitate reporting of all credentialing related activities to the THPG board of directors.

Ensure compliance with federal, state, and local regulations related to credentialing and privileging.

Maintain up-to-date knowledge of relevant laws, standards, and best practices.

Implement and maintain a comprehensive delegation oversight program which supports all aspects of credentialing delegation.

Data Management and Reporting

Oversee the maintenance of credentialing databases and ensure data integrity and confidentiality.

Generate and present regular reports on credentialing activities, status, and compliance metrics.

Conduct regular audits of credentialing files to ensure completeness and accuracy.

Implement continuous improvement initiatives to enhance credentialing processes and outcomes.

Responsible for ensuring thorough preparation of documentation, reports and any other information needed for regulatory and NCQA audits related to delegation oversight.

Team Leadership and Development

Lead, mentor, and develop the credentialing team, providing training and professional development opportunities.

Conduct performance evaluations and manage team workload and assignments.

Manage a team for data management, onboarding, provider enrollment, government enrollment, and maintenance.

Collaborate with medical staff, department heads, and administration to address credentialing issues and ensure alignment with organizational goals.

Communicate effectively with providers and internal stakeholders regarding credentialing requirements, status, and issues.

Identify and implement technological solutions to streamline and enhance the credentialing process.

Stay abreast of industry trends and innovations in credentialing practices.

Vendor and Contract Management

Manage relationships with relevant vendors.

Negotiate contracts and service agreements to ensure quality and cost-effectiveness.

Stakeholder Education and Support

Educate and support providers and staff on credentialing processes and requirements.

Serve as a resource for credentialing-related inquiries and provide guidance as needed.

Participate in ongoing support model meetings to include inquires about credentialing, billing, claims, or quality issues.

Education

Bachelor's Degree Healthcare Administration, Business, or related field. 4 Years Relevant experience in lieu of a degree. Required

Experience

8 Years Progressive experience in credentialing and/or medical staff services. Required

Licenses and Certifications

CPMSM - Certified Professional Medical Services Management Upon Hire Required

CPCS - Certified Provider Credentialing Specialist Upon Hire Preferred

Why Texas Health?

At Texas Health Resources, our mission is "to improve the health of the people in the communities we serve".

We are one of the largest faith-based, nonprofit health systems in the United States with a team of more than 24,000 employees of wholly owned/operated facilities plus 2,200 employees of consolidated joint ventures in the greater Dallas Fort Worth area. Our career growth and professional development opportunities are top-notch and our benefits are equally outstanding.

Join our award-winning Texas Health family and become a part of a team that is improving the health of our communities daily. You belong here.

Here are a few of our recent awards

• 2022 FORTUNE Magazine's "100 Best Companies to Work For®" (8 th year in a row)

• A "Top 100 Places to Work" for 2021 by The Dallas Morning News (10 th time)

• #1 as 2021 "20 Best Workplaces in Health Care and Biopharma" by Great Place to Work® and Fortune (7th consecutive year, 6th year as #1)

• "America's Best Employers for Diversity" list by Forbes

• A "100 Best Workplaces for Millennials" by Fortune and Great Place to Work®

• A 2021 LinkedIn Top Companies in Dallas - Fort Worth list. This award recognizes the best workplaces for team members to grow their careers and honors companies that not only attract talent but also invest in the development of their employees.

Explore our Texas Health careers site (~~~/) for info like Benefits (~~~) , Job Listings by Category (~~~) , recent Awards (~~~) we've won and more.

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Texas Health requires a resume when an application is submitted.Employment opportunities are only reflective of wholly owned Texas Health Resources entities.

We are an Equal Opportunity Employer and do not discriminate against any employees or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class.