Dir Credentials Verf

• Maintains a comprehensive system-wide web-based database including all licensed independent practitioners and advanced practice professionals affiliated with any Aurora Health Care facility and/or The Aurora Network. Provides data from this database for approved use throughout the enterprise through integration with other operating systems.
• Advises senior leadership regarding system wide and site policies for bylaws and policies related to credentialing and privileging.
• Directs and is responsible for system wide database and policy to support medical staff and advanced practice clinicians. Oversees database management, develops strategies for new technologies, provides statistical and analytical reports. Provides data from this database for approved use throughout the enterprise through integration with other operating systems.
• Ensures compliance with the Joint Commission, DNV, HFAP, CMS, OSHA, state law, and other standards and regulations. Coordinates system wide Accrediting Organization and NCQA standards in all departmental policies and activities.
• Develops, maintains and administers policies and procedures for the CVS, collaborating with customers as necessary to assure CVS policies and procedures meet customer needs and comply with all legal and regulatory requirements.
• Continually refines the credentials verification process and assures national best practices are implemented in order to meet organizational business needs and regulatory requirements. Click here to enter text.
• Manages the priorities of the CVS to meet the business, regulatory, fiscal and patient care needs of the organization by effectively collaborating with caregivers and leaders responsible for Medical Staff Services, The Aurora Network/Advocate Physician Partners, Physician Recruitment, Physician Integration, Provider Data Integrity, Revenue Cycle, Information Technology, the Medical Group, Employee Health, and Providers Directories. Maintain strong relationships with multiple levels of leadership within the organization. External contacts with Illinois Department of Public Health, Illinois Department of Professional Regulation, Accrediting Organization, NCQA, legal counsel, chief executives and physicians.
• Performs human resources responsibilities for staff which include interviewing and selection of new employees, promotions, staff development, performance evaluations, compensation changes, resolution of employee concerns, corrective actions, terminations, and overall employee morale.
• Develops and recommends operating and capital budgets and controls expenditures within approved budget objectives.
• Responsible for understanding and adhering to the organization’s Code of Ethical Conduct and for ensuring that personal actions, and the actions of employees supervised, comply with the policies, regulations and laws applicable to the organization’s business.

Licensure, Registration, and/or Certification Required:

• Credentialing Specialist, Certified Provider (CPCS) issued by the National Association Medical Staff Services (NAMSS).
• Medical Services Management, Certified Professional (CPMSM) issued by the National Association Medical Staff Services (NAMSS), or

Education Required:

• Bachelor’s Degree (or equivalent knowledge) in Health Care Administration or related field.

Experience Required:

• Typically requires 7 years of experience in health care credentialing and regulatory compliance. Includes 3 years of management experience in in healthcare credentialing and regulatory compliance.

Knowledge, Skills & Abilities Required:

• Strong interpersonal, oral, and written communication skills.
• Ability to successfully develop and maintain multiple, complex relationships across organization’s departments, hospital administration, medical staff, senior executives, and corporate staff. High degree of tact and judgment with insight into the many facets of the medical staff organization and hospital administration.
• Knowledge of accreditation standards, including but not limited to NCQA, The Joint Commission, DVS, CMS, OSHA, and state law.
• Excellent human resource management skills.
• Ability to effectively navigate a complex healthcare system.
• Strong understanding of processes and regulations related to Medical Staff credentialing, privileging, and peer review.
• Understanding of development and maintenance of operating and capital budgets.

Physical Requirements and Working Conditions:

• This position requires travel so there will be exposure to weather and road conditions.
• Operates all equipment necessary to perform the job.
• Exposed to a normal office environment.

This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.