Credentialing Program Manager - Central Verification Office

Responsibilities

• Manages and coordinates the credentialing and recredentialing process for all applicants to the OhioHealth Medical Staff, Allied Practitioner Staff, the Clinically Integrated Network (CIN), and/or the OhioHealthy Medical Plan.
• Utilizes three sets of credentialing policies and procedures managed by the CVO to support TJC accreditation for the OhioHealth hospitals and NCQA accreditation to support the CIN and OhioHealthy Medical Plan.
• Ensures all information is accurate and up to date prior to completing an application.
• Collaborates with applicants and/or credentialing contacts to resolve discrepancies in application documents.
• Collaborates with associates of other OhioHealth medical affairs teams, the CIN and/or OhioHealthy to address questions related to a provider’s credentialing application or status in the credentialing process.
• Completes the credentialing assignment and ensures compliance with regulatory guidelines, including all applicable policies and procedures that govern the credentialing department.
• Identifies applications that require medical director review by following credentialing department policies specific to the CIN and OhioHealthy, prepares the Medical Director Review (MDR) packet, and collaborates with CVO leadership when a review is needed.
• Maintains confidentiality for all credentialing/re-credentialing/membership issues.
• Participates in system-wide credentialing initiatives as identified (e.g., process improvement projects).
• Participates in KPI (key performance indicator) huddles as scheduled.
• Works individually and independently with minor supervision while meeting productivity expectations and maintaining high quality work.

Qualifications

• Bachelor's Degree
• Minimum of two years credentialing experience through a CVO-like department, or hospital medical staff/allied practitioner credentialing experience.
• Detailed understanding of TJC and NCQA credentialing requirements.
• Credentialing database management (Cactus or similar credentialing database).
• Familiarity with Microsoft products.