Senior Credentials Manager

Description

Penn Medicine is dedicated to our tripartite mission of providing the highest level of care to patients, conducting innovative research, and educating future leaders in the field of medicine. Working for this leading academic medical center means collaboration with top clinical, technical and business professionals across all disciplines.

Today at Penn Medicine, someone will make a breakthrough. Someone will heal a heart, deliver hopeful news, and give comfort and reassurance. Our employees shape our future each day. Are you living your life's work?

Senior Credentials Manager

Job Summary

• Responsible for the credentialing operations of the Penn Medicine Corporate Office of Medical Affairs ("OMA") directly including, but not limited to, its NCQA certified Credentials Verification Organization ("CVO). CVO completes and maintains credentials and privileges of 10,000 employed and non-employed (independent) Penn Medicine providers in accordance with hospital (The Joint Commission (TJC), Department of Health (DoH), and Centers for Medicare & Medicaid Services (CMS)) and payer (National Committee on Quality Assurance (NCQA)) standards. This function performs delegated credentialing for employed/billable Penn Medicine providers which feeds data to the enrollment team for payer enrollment which directly impacts Penn Medicine revenue and cash generation. Conducts all credentialing activities for all Penn Medicine hospitals and their provider-based sites, as well as Penn Medicine's licensed ambulatory surgical facilities (Penn Medicine entities).

Responsibilities

• Supports the AVP in drafting the annual Office of Medical Affairs strategic plan/goals and budgets and proposes updates as necessary; manages strategic initiatives in order to keep on time and on budget, and provides AVP with regular updates.

• Directly manages CVO Credentialing Operations Supervisor/Manager and all credentials staff not reporting directly to the CVO Credentialing Operations Supervisor/Manager; includes work allocation, training, promotion, enforcement of internal procedures and controls, and problem resolution; evaluates performance and makes recommendations for personnel actions; motivates employees to achieve peak productivity and performance.

• Holds primary responsibility for CVO's ongoing NCQA certification including but not limited to leading the biannual survey effort. Supports (Sr) Compliance Analyst with regulatory surveys/audits, and ensures compliance with TJC, DoH, CMS & NCQA standards.

• Manages and reports operational metrics. Monitors turnaround times for processing of credentials applications and has overall accountability for focus on delivery of a high quality product, with the greatest efficiency, in the least amount of time. Accountabilities include but are not limited to:

• 1. Application verification and evaluation management in accordance with the procedures detailed in the CVO Operating Manual;
• 1. Participation in new practice onboarding efforts and projects;
• 1. Review of privileging in accordance with current industry standards;
• 1. Ensuring expirables (licenses, DEAs, malpractice coverage, etc.) are kept current and status is reported to the Penn Medicine Medical Staff Office hospital (MSO) leaders;
• 1. Discrepancies in data passed to payer enrollment are minimized so that managed care payer enrollment is exported timely each month (or as otherwise appropriate) in a complete, correct and timely fashion so that to the maximum extent possible each provider's effective date is on/before the provider start date.

• Responsible for compliance with accrediting organization requirements and each of the Penn Medicine medical staff bylaws & accompanying manuals and credentials-related policies, development and review of CVO Operating policies and procedures, Managed Care Delegated Credentialing policies and procedures; develops, recommends, and/or implements changes, revisions, and enhancements as appropriate to current operating environment.

• Responsible for maintaining strong customer relationships with leaders and staff at Penn Medicine hospitals, ensuring that they understand their role in the credentialing process and that their providers are credentialed and privileged to meet their requested start dates to the maximum extent possible.

• Leads credentialing team in designing credentialing and privileging processes and in prioritizing and assigning resources devoted to process improvement, ensuring an appropriate level of quality control over credentialing and privileging work product.

• Coordinates provider privilege approval with the Penn Medicine hospital Medical Staff Offices.

• Works with OMA Managers to ensure that all CVO and hospital MSO staff have the necessary and appropriate training to be successful in their work.

• Serves as senior credentialing representative to outward facing customers, both within and outside of Penn Medicine.

• 1. Ensures that OMA is providing excellent service to its customers;
• 1. Primarily responsible for credentialing aspects of CVO integration projects;
• 1. Primary attendee of CVO Users Group and other operational meetings;
• 1. Primary credentialing participant in payer contract negotiation and contract implementation;
• 1. Oversight of new practice onboarding efforts.

• Performs duties in accordance with Penn Medicine and entity values, policies, and procedures.

• Other duties as assigned to support the unit, department, entity, and health system organization.

Credentials

NAMSS certification (CPCS and/or CPMSM)- within one year of employment (Preferred).

Education or Equivalent Experience

• Bachelor's degree, preferably in business, information management, health administration or related field (Required).

• 7+ years of experience with hospital credentialing and/or 'delegated credentialing experience' (Required).

• Master's degree, preferably in business, information management, health administration, or related field (Preferred).

Skills & Abilities:

• Must have the ability to maintain information in a confidential manner in accordance with all regulatory requirements

• Must be able to work effectively as a team leader, build effective teams, and drive employee engagement

• Must be able to meet deadlines and conduct operations within budget

• Must be able to exercise good judgment when escalating issues

• Strong verbal and written communication skills to enable sufficient, timely, and effective communications with providers and external contacts

• Proficient in computers and computer software, including but not limited to, database management, spreadsheet and word processing applications.

• Proficiency in Microsoft Office Suite.

We believe that the best care for our patients starts with the best care for our employees. Our employee benefits programs help our employees get healthy and stay healthy. We offer a comprehensive compensation and benefits program that includes one of the finest prepaid tuition assistance programs in the region. Penn Medicine employees are actively engaged and committed to our mission. Together we will continue to make medical advances that help people live longer, healthier lives.

Live Your Life's Work

We are an Equal Opportunity and Affirmative Action employer. Candidates are considered for employment without regard to race, ethnicity, color, sex, sexual orientation, gender identity, religion, national origin, ancestry, age, disability, marital status, familial status, genetic information, domestic or sexual violence victim status, citizenship status, military status, status as a protected veteran or any other status protected by applicable law.

REQNUMBER: UPHS-INFOR-216241