Credentialing Supervisor - Clinical Staff Office

UIOWA•Iowa City, IA

9d•Onsite

About The Position

The Clinical Staff Office (CSO) at UI Health Care has an opening for a full-time Credentialing Supervisor. The CSO provides Credentialing Verification Organization services for UI Health Care, Stead Family Children’s Hospital, and numerous UI Health Care Outreach clinics, external clients, managed care payers, State agencies, Colleges, and Student Health Centers. This includes obtaining and authenticating sensitive information and interpreting numerous sets of accrediting bodies’ standards and UI Health Care Bylaws, Rules & Regulations. Direct patient care practitioners are delineated privileges by the UI Health Care Clinical Systems Committee, and are not able to see, touch, or bill for patient services until these credentialing and verification processes have been completed in full. The Credentialing Supervisor provides specialized expertise in conducting a wide range of hospital privileging, managed care credentialing and verification activities while adhering to multiple policies and procedures. The successful candidate must be highly organized, have strong communication skills, a high level of technical computer expertise, excellent customer service skills, be a team player and be willing to go the extra mile to assure all functions are completed in a timely and professional manner. Must be able to manage multiple priorities and have strong problem-solving and critical decision-making skills.

Requirements

BA or BS degree, or combination of related education and experience is required.
1-3 years’ experience in a regulatory environment requiring attention to detail is required.
Knowledge of Joint Commission and NCQA standards is required.
Working knowledge of medical terminology is required.
Demonstrated proficiency in Microsoft Office Suite (including Outlook, Word, and Excel) is required.
Demonstrated excellence in written and oral communication skills is required.
Experience and successful record in managing multiple tasks, meeting deadlines and completing tasks in full is required.

Nice To Haves

Knowledge of UI Health Care Bylaws, Rules & Regulations is desired.
Some (6 months – 1 year) supervisory and/or training experience is desired.
Some (6 months – 1 year) administrative experience, including accounting is desired.

Responsibilities

Compile reports and statistics and includes interim and ongoing monitoring to ensure compliances are met.
Provide valuable resource knowledge as a liaison to internal and external entities.
Provide oversight and guidance over the Credentialing Specialists’ workload.
Responsible for coordination, preparation, and facilitation of Credentials Subcommittee meetings, privileging ballots and other actions; serves as a credentialing expert and liaison between the CSO and committees or UI Health Care leadership; prepares material for committee meetings; and coordinates processes and correspondence to satisfy internal and external regulations with respect to committee decisions.
Investigates and analyzes data for accuracy while adhering to compliance standards of accrediting and regulatory bodies (i.e., Joint Commission, NCQA, URAC); reviews prepared privileging packets for completeness and checklists files for managed care; monitors credentialing applications and materials with clinical department HR Representatives, Program Coordinators, DEOs, etc.; advises the Credentialing Specialists on primary source verification issues and assists Credentialing Specialists with contact information for primary source verification.
Supports daily credentialing operations of the office and clinical departments, including coordination of processes among colleagues, responding to routine and complex inquiries, analysis/modification of compliance standards and policies, and troubleshoots database problems for staff.
Exercises a high level of autonomy in addressing issues and making decisions; assists leadership in drafting department delineation statements, responding to inquiries and managing correspondence of findings and interpretation of policies, procedures and standards; and resolves issues concerning missing, questionable, or gaps in information to meet desired deadlines.
Maintains working knowledge of UI Health Care Bylaws, UI Health Care credentialing policies and procedures, and CSO policies and procedures; translates knowledge into action regarding credentialing and privileging activities at the individual provider level.
Conducts individual file audits to confirm adherence to multiple managed care criteria and institutional requirements.
Maintains comprehensive knowledge of current Joint Commission, National Committee for Quality Assurance (NCQA) and Center for Medicare/Medicaid (CMS) standards for continued compliance with mandated criteria.
Participates in weekly meetings with the Credentialing Specialists to assign, review and coordinate their workload according to established guidelines.
Audits the Credentialing Specialists’ files and gives guidance on resolving issues.
Participates in monthly Quality Improvement meetings for continued development of process improvement as well as policy development and revision of current policies and practices; suggests improvements as issues arise.
Maintains and processes reports and documentation, including committee manuals, invoices for client credentialing and privileging, and creating managed care reports for payor loading.
Prepares and educates department contacts on a regular basis about JC standards, NCQA standards and UI Health Care policies and procedures related to credentialing and privileging practices within the department and coordinated with CSO activities.
Acts as Administrator of the National Practitioner Data Bank (NPDB) for the Clinical Staff Office. Enters data into the NPDB and conducts queries for any malpractice settlements, privilege suspensions or license sanctions, and prepares and coordinates this information in preparation for committee review.
Processes file terminations for outside clients as needed.
Provides back-up support for IPPE/OPPE/FPPE process (i.e. Initial Professional Practice Evaluation/Ongoing Professional Practice Evaluation/Focused Professional Practice Evaluation).
Works to support the Clinical Staff Office leadership, including the Chief Medical Officer and CSO Director, and provides back-up for the CSO Director when needed.
May assist in interviews and hiring of new staff for the Clinical Staff Office.
Trains Credentialing Specialists on CSO processes and database and provides feedback on performance evaluations.
Performs other duties as assigned.