Director of Credentialing & Verification Office - Clinical Affairs

The University of Kansas Health System•Kansas City, KS

9d•Onsite

About The Position

The Director of Credentialing and Verification Office is a system leadership role in Clinical Affairs responsible for leading and managing enterprise-wide verification, credentialing, and medical staff office capabilities. The director standardizes verification and credentialing processes across the organization and creates a structure for consistent focused professional practice evaluation (FPPE) at each site. The role oversees Medical Staff Office Coordinators and Managers to ensure medical staffs receive appropriate support. The director leads the centralized verification function, including a common application, primary source verification, application management, provider-enrollment data gathering, and ongoing monitoring of sanctions and expirables. As the enterprise process leader for provider credentialing and business owner of the credentialing system or platform, the director drives continuous improvement across credentialing and related processes, including provider enrollment and onboarding. The role develops and monitors performance measures, oversees initial credentialing and re-credentialing, delegated payor audits, and medical staff office support, and leads one or more medical staff office managers and their teams. The position reports to the Associate Chief Medical Officer in the Clinical Affairs Department.

Requirements

Bachelor’s degree in a related field, such as healthcare management or business administration, from an accredited college or university.
Five or more years of healthcare experience, specifically 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 the provider enrollment process.
Certified Provider Credentialing Specialist (CPCS) certification from the National Association of Medical Staff Services (NAMSS), or obtain certification within 12 months of hire.
Understanding of accreditation and regulatory standards related to medical staff functions, including Joint Commission, CIHQ, NCQA, and CMS.
Ability to establish and maintain effective working relationships with all levels of health system staff.
Excellent interpersonal and communication skills.
Strong presentation and leadership skills.
Strong PC skills, including Word, Excel, Outlook, PowerPoint, Visio, and Teams or equivalent.

Nice To Haves

Master’s degree in a related field from an accredited college or university.
Two or more years of medical staff office administrative management.

Responsibilities

Create and continuously improve a centralized verification organization function that enables all TUKHS to initiate a common application.
Lead the enterprise-level credentialing verification function, including primary source verification, application management, initiating data gathering for provider enrollment, and ongoing monitoring of sanctions and expirables.
Serve as the enterprise process leader for provider credentialing and business owner for the credentialing system or platform.
Continuously improve provider credentialing processes and related processes such as provider enrollment and onboarding.
Develop and monitor key performance indicators and metrics to assess credentialing effectiveness, efficiency, and compliance.
Lead one or more medical staff office managers and their teams.
Oversee initial credentialing and re-credentialing of all providers.
Ensure provider licensures and required certificates are current and filed in credentialing files.
Support medical staff office capabilities, including Medical Staff Executive Committees, medical staff meetings, and other appropriate meetings.
Oversee delegated payor audits.
Perform the professional, clinical, or technical competencies of the assigned unit or department.