Director, Credentials Verification Organization

1000 Wellstar Health System, Inc.•Marietta, GA

About The Position

The Director, Credentials Verification Organization (CVO) provides strategic leadership for Wellstar’s system CVO and is responsible for maintaining a high-quality, comprehensive credentialing and privileging program. The role oversees the system application process for credentialing and privileging practitioners in accordance with Wellstar bylaws, rules, regulations, and policies. It manages processing-time expectations and communications with applicants, vendors, and other Wellstar departments, and monitors applicable state and federal laws, statutes, and accreditation standards, including State, CMS, and Joint Commission requirements. The Director oversees credentialing and privileging for Medical Staff, Advanced Practice Professionals, and Allied Health Professionals across Wellstar hospitals, Wellstar Medical Group, PHO, Wellstar Clinical Partners, and delegated managed-care credentialing. The role ensures applications are processed in accordance with applicable bylaws, standards, and regulations; credentialing information is analyzed; electronic files and required documents remain current; applicants receive appropriate communication; and the CVO interfaces appropriately with Legal and Risk Management. The position serves as a regulatory and accreditation resource, supports continuous survey readiness, and coordinates revisions to bylaws, policies, rules, and regulations as needed. It acts as a liaison among Medical Staff, Administration, Senior Leadership, departments, and attorneys on relevant medico-legal matters. The Director also leads staff management and development, departmental structure and workload evaluation, customer service, and departmental financial planning, including operating and capital budgets.

Requirements

Bachelor’s degree in Business Administration/Management or Health Administration required; relevant work experience and/or specialized training may be substituted for the minimum education requirement.
At least 8 years of comprehensive medical staff services experience in a hospital or CVO setting, with increasing responsibility and supervisory experience.
Experience using medical staff database technology and ability to support optimal use of the database.
Working knowledge of medical staff credentialing and privileging processes and comprehensive knowledge of state and federal regulatory requirements and accreditation standards related to the organized medical staff.
Documented experience with multiple medical staff departments and committees and supervisory responsibility for five or more support staff.
Working knowledge of medical staff governance, practitioner credentialing and privileging, and applicable Joint Commission and NCQA standards for medical staff organization.
Knowledge of current federal and state laws and regulations relevant to medical staff functions, with ability to draft document revisions needed for compliance.
Ability to lead, manage, or effect change; use discretion and independent judgment in problem solving and decision support; and maintain confidentiality of medical staff and peer review information.
Ability to multitask, prioritize, delegate, organize, and meet established deadlines.
Ability to adapt to a flexible work schedule with frequent interruptions; strong communication and interpersonal skills; ability to motivate and lead; and ability to work promptly and consistently with little direct supervision.
Excellent problem-solving and judgment skills, including responding appropriately to changing circumstances, and ability to communicate effectively in writing and oral presentations to individuals and groups.
CPCS (Certified Provider Credentialing Specialist) certification preferred upon hire.
CPMSM (Certified Professional in Medical Services Management) certification preferred upon hire.

Nice To Haves

CPCS (Certified Provider Credentialing Specialist) certification upon hire.
CPMSM (Certified Professional in Medical Services Management) certification upon hire.

Responsibilities

Oversee a high-quality, timely, cost-effective, single-application credentialing and privileging process for Medical Staff, Advanced Practice Professionals, and Allied Health Professionals across Wellstar entities and delegated managed-care organizations.
Ensure application processes comply with Medical Staff Bylaws, Joint Commission and NCQA standards, CMS requirements, and state and federal regulations.
Analyze credentialing information and maintain current electronic credential files and required documentation, including licenses, DEA documentation, liability insurance, and board certification.
Oversee communication with applicants about membership and privileging and ensure appropriate coordination with Wellstar Legal and Risk Management.
Maintain current knowledge of laws, statutes, regulations, and accreditation standards; guide Medical Staff Leadership and the organization; and identify needed document amendments for compliance.
Coordinate and participate in development and revision of Medical Staff documents, and act as a liaison between Medical Staff and Health System attorneys on medico-legal issues as needed.
Serve as liaison among Medical Staff, Administration, Senior Leadership, and other departments; promote customer service, communication, and teamwork; and provide reports as required.
Collaborate with Senior Leadership to set Medical Staff Services goals aligned with system strategic goals.
Set staff expectations and goals; oversee recruitment, development, job performance standards, evaluations, cross-training, education, and leadership development.
Interview, hire, and orient direct-report staff; complete their performance evaluations; evaluate departmental structure, reporting relationships, and workload; and address staffing issues and grievances as appropriate.
Identify customer-service needs, improve service, conduct department meetings and in-services, and promote a positive work environment.
Develop and coordinate operating and capital budgets; oversee budget evaluations, variance reporting, and action planning; and oversee or implement new or revised programs.
Perform other duties as assigned and comply with Wellstar Health System policies, standards of work, and code of conduct.