Quality Compliance Manager

TeleSpecialists LLC•Brookhaven, GA

1d•Onsite

About The Position

The Credentialing & Licensing Regulatory Compliance Manager is responsible for ensuring TS policies and procedures meet and abide by the proper credentialing and licensing of providers to be compliant of The Joint Commission (TJC), National Committee for Quality Assurance (NCQA), and medical state licensure regulations and certifications. Manage the QA Audits from each department within the C&L division and monitor areas for additional education along with process improvements.

Requirements

Certified Provider Credentialing Specialist (CPCS) and/or Certified Professional Medical Ser-vices Management (CPMSM) required
Quality & Compliance experience required
Experience with Credentialing Accreditation by The Joint Commission and/or National Committee for Quality Assurance required
Credentialing experience required
Values and models integrity and honesty by acting in a just, fair, and ethical manner and encouraging ethical behavior, among others. Inspires trust and confidence among stakeholders through reliability, authenticity, and accountability
Establishes productive, cooperative relationships with subordinates, peers, management, and stakeholders both internal and external to the organization.
Understands and responds to others’ needs and priorities.
Gives and seeks feedback that will increase the productivity of relationships and networks with peers and associates to build a support base
Manage multiple tasks, meet deadlines, and prioritize multiple projects that require detail-orientation
Ability to interact with internal and external customers
Flexible and adaptable in learning and understanding new technologies
Highly analytical and detail-oriented with ability to demonstrate command of details and to articulate those details at a higher level.
Strong written, oral, and interpersonal communication skills
Highly self-motivated, directed, and initiative-taking
Keen attention to detail
Ability to effectively prioritize and execute tasks in a high-pressure environment
Able to communicate effectively within department and with members of interdisciplinary teams
Ability to work independently and proactively in a fast-paced environment
Proven analytical and problem-solving skills

Nice To Haves

Physician licensure experience preferred
BA/BS preferred or equivalent

Responsibilities

Monitors and manage updates on regulatory state licensing guidelines, and standardization of credentialing in meeting NCQA and TJC requirements for all departments.
Review and manage credentialing & licensing policies and procedures update process
Ensure established processes and procedures are monitored
Analyze trends allowing for proper development of materials for regulatory and compliance
Review and manage the audit process of at least 5% to 10 % of providers’ files for quality assurance
Utilize reports and dashboards to ensure regulatory, quality, and compliance against established processes, deadlines, and metrics
Coordinate the monthly regulatory & compliance educational sessions for credentialing and licensing staff
Identify opportunities for improvement to increase quality, compliance, effectiveness, and efficiency
Facilities annual review and update of applicable governing documents (bylaws, credentialing policies, rules, DOPs) that support and direct organizational practices and ensure compliance
Works with C&L leadership to create, maintain, and analyze job work instructions for the efficiencies of the division while utilizing the credentialing software
Ability to assume responsibility and exercise good judgement in making decisions within the scope of authority of the position
Must demonstrate and promote a positive collaborative environment
Assist with certification surveys for NCQA, TJC, ISO, and any other efforts regarding credentialing