Director of Credentialing & Verification Office - Clinical Affairs

Position Summary / Career Interest:

The Director of Credentialing and Verification Office is a system leadership position responsible for leading and managing enterprise-wide verification, credentialing, and oversight of medical staff office capabilities. The Director will be responsible to standardize the verification and credentialing processes across the organization as well as create a structure for consistent FPPE to occur at each site. The Director will have oversight of the Medical Staff Office Coordinators/Managers to ensure each medical staff is provided the level of support necessary.


Responsibilities and Essential Job Functions

• Reports to the Associate Chief Medical Officer in the Clinical Affairs Department.
• Responsible for creation and continuous improvement of a centralized verification organization function, enabling all TUKHS to initiate a common application.
• Oversees and leads enterprise-level verification function for credentialing process including primary source verification, application management, initiating data gathering for provider enrollment, and performing ongoing monitoring of sanctions and expirables.
• Act as enterprise process leader for provider credentialing and business owner for credentialing system/platform.
• Responsible for continuous improvement in provider credentialing processes and overlapping processes such as provider enrollment and onboarding.
• Develops and monitors key performance indicators and metrics to assess provider credentialing effectiveness, efficiency and compliance.
• Leads one or more medical staff office managers and their teams.
• Oversees the initial credentialing and re-credentialing of all providers.
• Ensures that all licensures and other required certificates are up to date and filed in the provider’s credentialing file.
• Provides support for the Medical Staff Office capabilities including but not limited to, Medical Staff Executive Committees, Medical Staff meetings, and other appropriate meetings.
• Oversees delegated payor audits.
• Must be able to perform the professional, clinical and or technical competencies of the assigned unit or department.
• These statements are intended to describe the essential functions of the job and are not intended to be an exhaustive list of all responsibilities. Skills and duties may vary dependent upon your department or unit. Other duties may be assigned as required.

Required Education and Experience

• Bachelors Degree in a related field (healthcare management, business administration, etc) from an accredited college or university.
• 5 or more years of experience in healthcare with specific experience in medical staff office affairs, credentialing, or provider services.
• Experience with delegated credentialing.
• Experience leading and managing direct reports, preferably in a production-related management role.
• Experience with provider enrollment process.

Preferred Education and Experience

• Master's Degree in related field from an accredited college or university.
• 2 or more years of medical staff office administrative management.

Required Licensure and Certification

• Certified Provider Credentialing Specialist (CPCS) - National Association of Medical Staff Services (NAMSS) or obtain certification within 12 months of hire.

Knowledge Requirements

• Understanding of accreditation and regulatory standards related to medical staff functions (Joint Commission, CIHQ, NCQA, CMS, etc).
• Ability to establish and maintain effective working relationships with all levels of health system staff.
• Excellent interpersonal and communication skills.
• Must have strong presentation and leadership skills.
• Strong PC skills (Word, Excel, Outlook, PowerPoint, Visio, teams or equivalent).

We are an equal employment opportunity employer without regard to a person’s race, color, religion, sex (including pregnancy, gender identity and sexual orientation), national origin, ancestry, age (40 or older), disability, veteran status or genetic information.