Manager System Credentialing

Work location: Texas Health Resources
Core work hours: Monday – Friday; 8:00a-5:00p; Hybrid work opportunity with 3 days in office.

About the Role

Oversees functions and efforts associated with credentialing of physicians, advanced practice providers (APPs) and allied health professionals (AHPs) to wholly owned entities and guidance to joint venture entities across the healthcare system. Assists Director in the development of a delegated credentialing program and maintains compliance with national accreditation bodies with the goal of starting and managing a Credentialing Verifications Organization (CVO). Collaborates with Director to provide system oversite and management of processes for credentialing, auditing of credentialing files and overall quality assurance of the system credentialing program. Assists in the development of credentialing policies and procedures, facilitates training to credentialing coordinators and specialists.

Responsibilities

• Act as administrative representative for Medical Affairs:
  • Available to members of the medical staff as an avenue to voice issues or concerns they may have with operations.
  • Respond timely and appropriately to inquiries.
  • Forward issues as well as recommendations for improvement to applicable hospital's administrative team.
  • Use knowledge and experience with medical staff organization and process to make recommendations to Director and other appropriate leadership teams.
  • Assist with gathering benchmark information relevant to issues facing medical staff leaders.
  • Provide support to clarify credentialing issues with the Hospital Medical Staff Offices.
  • Maintain records for communication and global information that is disseminated to the medical staff and the Hospital Medical Staff Offices.
• Oversee credentialing and recordkeeping for medical staff functions:
  • Monitor an efficient and compliant credentialing process for members of the medical staff, APPs and AHPs.
  • Advise the Medical Staff Coordinator and Credentialing Specialist regarding difficult credentialing or auditing issues.
  • Responsible for complete and accurate credentialing files and the maintenance of same through the Medical Staff Coordinator and Credentialing Specialist.
  • Responsible for timely notification to all applicants of the status and routing of their credentialing file.
  • Ensure that timely credentials reports are provided to the hospital Medical Staff Offices for information or action to be routed through the entity's Chair of the Credentials Committee, Medical Executive Committee and to the Board of Trustees for information or action.
  • Monitor current licensure/certification/registration and professional liability coverage for all physicians, APPs and AHPs at all times and take appropriate action as necessary.
• Ensure regulatory compliance and accreditation:
  • Assist in the development and implementation of policies and procedures to ensure credentialing activities meet or exceed regulatory standards and withstand external audits.
  • Collaborate with government and regulatory staff and entity Medical Staff Office leaders on accreditation audits and surveys, including direct interactions with surveyors, documentation preparation, and staff training, as needed.
  • Monitor and interpret regulatory changes, updating policies and procedures accordingly to maintain compliance and reduce risk exposure.
  • Collaborate with Director and THPG credentialing leaders regarding the maintenance of integration of credentialing and privileging process of entity and THPG credentialing, ensuring adherence to medical staff bylaws and payer requirements.
  • Maintain knowledge of the Joint Commission requirements pertaining to medical staff for continued accreditation. Assess standard compliance and provide recommendations to maintain compliance.
  • Maintain working knowledge of hospitals' Medical Staff Bylaws and Rules & Regulations.

Requirements

• Individual must be able to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
• This role requires the ability to solve problems, think outside-the-box, and be resourceful; must be result-oriented, a quick learner and self-starter.

Qualifications

• Education:
  • H.S. Diploma or Equivalent Required
  • Bachelor's Degree Required
• Experience:
  • 9 years in hospital medical staff services to include 2 years progressive increase in duties, supervisory/leadership experience with H.S. diploma Required
  • 5 years in hospital medical staff services to include 2 years progressive increase in duties, supervisory/leadership experience with Bachelor's degree Required
  • Acute Care Experience Strongly Preferred
• Licenses and Certifications:
  • CPCS - Certified Provider Credentialing Specialist within 12 months of hire Required
  • CPMSM - Certified Professional Medical Services Management within 3 years of hire Required

Skills

• Creates and perpetuates a culture in which decisions/actions that are consistent with THR Mission, Vision, Values and Promise are the norm.
• Acts as a role model for THR's Mission, Vision, Values, and the Promise.
• Ability to manage people.
• Ability to work within and promote a team environment.
• Ability to execute or co-manage multiple projects and deadlines.
• Expert knowledge of TJC standards as well as federal and state regulations with regard to medical staff credentialing.
• Strong analytical skills.
• Strong written and verbal communication skills, including ability to effectively present information in group settings.

Benefits

At Texas Health Resources, our mission is “to improve the health of the people in the communities we serve”. As part of the Texas Health family and its 28,000+ employees, we’re one of the largest employers in the Dallas Fort Worth area. Our career growth and professional development opportunities are top-notch and our benefits are equally outstanding.