Associate Director of Credentialing

ERIE FAMILY HEALTH CENTER • Chicago, IL

121d • $84,000 - $97,000

About The Position

Join the Erie team! Motivated by the belief that healthcare is a human right, we provide high quality affordable care to support healthier people, families, and communities. Erie delivers holistic care to help every member of the family stay healthy and active from infancy through adulthood. Since 1957, we have provided high-quality care to diverse patients most in need, regardless of their insurance status, immigration status, or ability to pay. Erie Family Health Centers, a nationally recognized top workplace with 13 sites in Chicago and suburbs, is looking for a valuable addition to our Credentialing team! The Associate Director of Credentialing supports the Director of Credentialing by overseeing initial credentialing, recredentialing, privileging, and ongoing monitoring of credentials and regulatory requirements for all licensed and credentialed providers and employees of Erie Family Health Centers; responds to regulatory changes and assists with strategic directions to ensure operational efficiency and compliance with all credentialing-related functions; develops implementation tools, techniques, and evaluation protocols to oversee and improve a centralized process and to maintain high standards for compliance.

Requirements

• High School diploma or equivalent required.
• Current NAMSS Certification as Certified Professional Medical Services Management (“CPMSM”) or Certified Professional Credentialing Specialist (“CPCS”).
• Current ten (10) or more years of experience with progressive responsibilities managing the full healthcare credentialing processes, including but not limited to hospital or group practice, central verification office, payer enrollments, medical staff privileging, and database management.
• Proven (verified) experience with credentialing and privileging processes and procedures, functions and maintenance of a central verification office and services, developing and editing privileges forms and privileges criteria.
• Comprehensive knowledge of accrediting and regulatory agencies’ standards.
• Ability to communicate effectively and in a highly professional manner in speech and writing, with individuals and groups.
• Ability to manage teams and workflows.
• Ability to manage, query and analyze credentialing databases; ability to develop and implement credentialing database workflows.
• Excellent analytical and problem-solving skills together with judgment and initiative.
• Strong organization and planning and project management skills.
• Computer skills, including proficiency with Microsoft Office programs, administration of credentialing and privileging software and database.

Nice To Haves

• Undergraduate or graduate degree in healthcare or business management a plus.
• Dual certification a plus (both a NAMSS Certification as Certified Professional Medical Services Management (“CPMSM”) and Certified Professional Credentialing Specialist (“CPCS”).
• Five (5) or more years of experience in a Central Verification Office a plus.
• Knowledge of National Committee on Quality Assurance (“NCQA”) credentialing standards a plus.
• Knowledge of federally qualified health center requirements a plus.
• Working knowledge of credentials verification offices and databases (Verity, HealthStream, or Echo credentialing platforms a plus).
• Knowledge of National Practitioner Data Bank interface and reporting (a plus).

Responsibilities

• Collaborates with the Director of Credentialing with developing and implementing policies and protocols necessary to verify and ensure that Erie licensed independent practitioners and other licensed and certified clinical staff are processed in accordance with Erie and industry practice standards and ensures successful results on external surveys or audits of regulatory practices.
• Supervises, trains and coaches Credentialing Specialists, new and current, to ensure performance outcomes for department’s goals.
• Directs and oversees all aspects of credentialing processes to ensure compliance with all standards, bylaws, state and federal requirements, accreditation standards (includes but not limited to National Committee for Quality Assurance (“NCQA”), Health Resources Services, Administration (“HRSA”) and Centers for Medicare and Medicaid (“CMS”)), payer plans and enrollments, immigration support, professional liability coverage and protections, and Human Resources.
• Manages all disclosures of claims history, adverse and disciplinary actions with Director of Credentialing, Chief Clinical Officer, and Compliance Officer.
• Participates with submission of regulatory reporting of disclosures to hospitals, payer plans, and to State and federal agencies.
• Maintains knowledge of current and changing regulatory requirements and assists with necessary policy revisions, communication of changes to credentialing specialists, HR and provider leadership, and other Erie employees and business partners.

Benefits

• Medical, Dental, Vision, Life and Disability Insurance.
• Flexible Spending (FSA) for Health Care or Childcare.
• 401(k) program with Erie matching $0.50 for every $1.00 up to the first 5% of the employee’s biweekly salary.
• Annual Paid Time Off: starting at 20 days of PTO, and 8 paid holidays.
• Competitive salary, annual merit increases, plus room for growth and career advancement.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED
• Number of Employees: 501-1,000 employees