About the Job:
The Director of Credentialing will lead Summit Behavioral Health’s credentialing process ensuring the organization optimizes revenue, minimizes risk and delivers excellent service to internal and external stakeholders. Responsibilities include leading, coordinating, implementing, monitoring and maintaining the end-to-end process for provider, payor, and facility credentialing. The Director will be accountable for the effectiveness of the credentialing process, including creating standard operating procedures, leading process improvement initiatives, and providing guidance to facility governance boards on privileging matters. The Director will collaborate with others in the organization, working across the credentialing spectrum, in the areas of facility accreditation, facility credentialing, provider privileging, provider enrollment, and payor enrollment. Summit’s Director of Credentialing will also be accountable for developing relationships with internal and external stakeholders to support and further the company in its goals for growth.
Roles and Responsibilities:
- Collaborate with others working within specific domains of credentialing such as payor contracting and facility management to achieve results.
- Collaborate with corporate leaders in other areas such as legal, quality, review boards, and payor contracting.
- Ensure that credentialing turnaround times consistently meet or exceed industry benchmarks.
- Maintain master credentialing database ensuring data accuracy and information integrity.
- Serve as business owner for one or more software applications used in the credentialing process.
- Remain aware of new credentialing processes and maintain compliance with regulatory, state, federal and accrediting entities.
- Establish and maintain positive working relationships with internal and external stakeholders.
- Facilitate creation and maintenance of Standard Operating Procedures; department Policies and Procedures, training and resource department materials.
- Assist facility governing boards by providing education and ensuring that privileges are consistently documented.
- Audit and review the organization’s credentialing results and reports including data integrity, accuracy, productivity to discover process improvement opportunities.
- Assist in development of KPIs and metric reports.
- Encourage continued educational and professional development.
- Travel if needed.
Education/Experience/Skill Requirements:
- Bachelor’s degree in healthcare or related field required.
- Seven or more years of related credentialing experience required.
- Seven or more years of healthcare experience required.
- Two or more years’ experience leading in a shared service operating model preferred.
- Demonstrated knowledge of credentialing and enrollment.
- Experience working with Credentials Verification Organizer (CVO).
- Experience working with delegated credentialing.
- Ability to effectively manage priorities, drive results, and take initiative.
- Strong communication and organization skills.
- Must be proficient in Microsoft Word, Excel, and PowerPoint.
Why Summit Healthcare Mgmt? Summit Healthcare Mgmt offers a comprehensive benefit plan and a competitive salary commensurate with experience and qualifications. Qualified candidates should apply by submitting a resume. Summit Healthcare Mgmt is an EOE.
Veterans and military spouses are highly encouraged to apply. Summit BHC is dedicated to serving Veterans with specialized programming at our treatment centers across the country. We recognize and value the unique strengths of the military community in supporting our mission to serve those who have served.
Job Type: Full-time
Pay: $130,000.00 - $150,000.00 per year
Benefits:
- 401(k)
- 401(k) matching
- Dental insurance
- Employee assistance program
- Employee discount
- Flexible spending account
- Health insurance
- Health savings account
- Life insurance
- Paid time off
- Vision insurance
Schedule:
Work Location: In person