Manager Credentialing

Major Responsibilities:

• Implements credentialing policies, procedures, and operating standards according to accrediting organizations (DNV, TJC, NCQA, state law, and other regulatory and legal standards).
• Collaborates with the CVS Director to develop and implement a protocol for timely and thorough processing of all new applications, reappointments and other credentialing events, as assigned, to the medical and advanced practice professional staff of Advocate Aurora hospitals, and managed care customers, in keeping regulatory and legal requirements and standards.
• Serves as a subject matter expert and resource for Advocate Aurora's credentialing software. Develops, maintains and releases reports needed by the organization with support from software analysts and Information Technology team members.
• Provides daily oversight, training, and ongoing assistance to CVS staff.
• Oversees the auditing of department data to ensure accuracy and adherence to established standards.
• Manages communication and customer relations related to credentialing activities.
• Manages the processes in the credentialing database in collaboration with other appropriate Credentialing leaders to assure consistent, accurate, confidential, and appropriate security and use of database information.
• 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), or
• Medical Services Management, Certified Professional (CPMSM) issued by the National Association Medical Staff Services (NAMSS).

Education Required:

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

Experience Required:

• Typically requires 5 years of experience in health care credentialing. Includes 1 year of supervisory experience in in healthcare credentialing.

Knowledge, Skills & Abilities Required:

• Knowledge of accreditation standards, including but not limited to NCQA, The Joint Commission, DVS, CMS, OSHA, and state law.
• Human resource management skills.
• Ability to effectively navigate a complex healthcare system.
• Strong understanding of processes and regulations related to credentialing.

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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.