Director of Credentialing & Verification Office - Clinical Affairs

The University of Kansas Health System•Kansas City, KS

About The Position

The Director of Credentialing and Verification Office is a system leadership position in Clinical Affairs responsible for enterprise-wide verification, credentialing, and oversight of medical staff office capabilities. The Director standardizes verification and credentialing processes across the organization and establishes 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, manages the enterprise credentialing process and its systems, and drives continuous improvement across credentialing and related provider enrollment and onboarding processes. The position also oversees provider credentialing and re-credentialing, compliance monitoring, performance measures, delegated payor audits, and support for medical staff committees and meetings. This role 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.
At least 5 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 ability to 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.
At least 2 years of medical staff office administrative management experience.

Responsibilities

Create and continuously improve a centralized verification organization function that enables all TUKHS to initiate a common application.
Oversee and lead the enterprise-level verification function for credentialing, including primary source verification, application management, initiating data gathering for provider enrollment, and ongoing monitoring of sanctions and expirables.
Act 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 required licenses and certificates are current and filed in provider 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, and/or technical competencies of the assigned unit or department.