Manager, Credentialing Verification Services

Company Name:
MetroSouth Medical Center
Health Systems Professional
Corporation is one of the leading operators of general acute care hospitals. The organization's affiliates own, operate or lease 135 hospitals in 29 states, with an aggregate of approximately 19,800 licensed beds. The consolidated organization owns and leases community hospitals that offer quality, cost-effective healthcare including a range of inpatient medical and surgical services, outpatient treatment and skilled nursing care. In over 60 percent of the markets served, CHS-affiliated hospitals are the sole provider of healthcare services.
Community Health Systems Professional Services Corporation seeks a Credentialing Verification
for its Franklin, TN, headquarters' Credentialing Verification Services team.
Summary: The Manager leads, directs and monitors the function and activities related to Delegated Credentialing and Recredentialing of all providers in compliance with NCQA guidelines. Enrolls providers with government payors as required. Ensures timely and accurate documentation submitted on behalf of providers to managed care plans.
Essential Duties and Responsibilities
Manage and monitor performance metrics for each provider
Ensure compliance with National Committee for Quality Assurance (NCQA)
Manage and monitor performance metrics for each provider
Provide ongoing monitoring of Audit Medicaid/Medicare sanctioning reports to ensure compliance with Health Care Financing Administration (HCFA) requirements regarding prohibition of excluded provider participation
Administer maintenance of applicable credentialing policies and procedures
Monitor and track onsite physician office visits and record reviews (if applicable)
Coordinate and report all rosters to each payor in timelyfashion
Participate in credentialing audits and/or corrective action plans as required
Schedule and prepare committee meetings and minutes.
Interact with clinic contacts on an on-going basis to review contract issues.
Provide monthly audit reports to Director Physician Operations
Assist with achieving NCQA accreditation
Reasoning Ability:
Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.

To perform this
successfully, an individual should have solid knowledge of Word, Excel, Power Point, Outlook, Share Point, and Constant Contact.
Supervisory Responsibilities:
6-8 team members
Bachelor's degree (B. A.) from four-year college or university; or one to two years related experience and/or training; or equivalent combination of education and experience required.
Knowledge of Joint Commission and/or NCQA required
Experience in Medical Staff Services or Delegated Credentialing preferred
Excellent verbal communication skills required
Job: Physician Practice
Primary Location: TN-Franklin (Nashville Region)
Organization: Credential Verification Services

Status: Full-time
Req ID: 1421009

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