Credentialing Lead - Positive Work Culture

Virtus Healthcare Staffing is partnering with a leading health services organization in Phoenix, AZ to find an exceptional Credentialling Lead to join their team! In this pivotal role, you'll take the lead on all credentialing activities, ensuring a smooth and efficient process while fostering positive relationships with healthcare providers.

Make a Significant Impact:

As the Credentialling Lead, you'll be responsible for leading and managing all aspects of the credentialing process, upholding the highest standards of quality and compliance. Your key responsibilities will include:

• Overseeing Credentialing Operations: Manage health plan requests, audits, and delegated credentialing programs to maintain strong relationships with health plans, physicians, providers, and practice managers.
• Expert Guidance: Provide expert guidance and leadership on all credentialing projects, supporting and directing other team members while exercising initiative and judgment in implementing new initiatives.
• Thought Leadership: Be a thought leader within the credentialing department while contributing to broader healthcare projects, demonstrating an understanding of the wider business.
• Compliance and Process Improvement: Maintain and update all credentialing policies and processes to ensure compliance with NCQA standards and state regulations, continuously seeking opportunities for improvement.
• Network Operations: Manage day-to-day network operations, including roster management and physician panel maintenance, while readily accessing guidance from experienced colleagues.
• Collaboration and Communication: Promote a positive and productive work environment, fostering collaboration within the team and across other organizational departments.
• Subject Matter Expertise: Serve as a subject matter expert on credentialing responsibilities and network relationship management.

Your Expertise is Valued:

• Credentialing Management: Lead the coordination of all credentialing activities, including initial appointments, reappointments, privileging, and data management.
• Data Management and Reporting: Oversee medical staff credentialing software and databases, ensuring data accuracy and generating comprehensive credentialing reports.
• Quality Assurance: Implement and monitor procedures for physician and provider credentialing/re-credentialing, tracking delegation oversight, re-credentialing activity, and corrective actions.
• Partnership and Negotiation: Partner with the provider network contracting team to negotiate contracts with delegated vendors.

You're a Strategic Thinker:

• Technical Expertise: Work independently, requiring only occasional technical support for complex situations. Use your in-depth knowledge to develop models and procedures while monitoring data trends and providing expertise in statistical analysis.
• Problem Solving: Resolve non-routine issues escalated from team members, demonstrating strong judgment and critical thinking skills.

Qualifications:

• Associate's degree in Medical Staff Services Science, Business, or a related field, or an equivalent combination of education and experience.
• Minimum five years of recent experience in medical staff services with extensive experience in credentialing, privileging, and roster management.
• Strong leadership capabilities, with a proven track record of leading projects, process improvement efforts, and motivating a team.
• Ability to work independently with limited supervision while collaborating effectively within a team environment.
• Thorough understanding of state/federal and NCQA regulatory requirements related to credentialing.
• Excellent customer service skills, exceptional time management and organizational skills, and strong written and verbal communication abilities.

Are You Ready to be a Leader in Credentialing?

If you're a passionate and experienced professional seeking a leadership role in credentialing, we encourage you to apply! Submit your resume and cover letter to Virtus Healthcare Staffing today.