Job Description

General Hours of Work: Monday-Friday (Days, 8:00 AM -5:00 PM, some evenings/weekends)

Exempt/Nonexempt: Exempt (salaried)

Department/Unit: Corporate - Clinical

Reports To: COO

SUMMARY: 

The Director is responsible for administering the functions of Avel eCare’s medical staff services. This individual directs a team of Licensing and Credentialing Staff who are responsible for primary source credentials verification, licensing, credentialing, privileging, and payor enrollment of Avel eCare clinical providers, including advanced practice and allied health providers. In addition, the Director is responsible for credentialing analysis, quality assurance, planning, customer/vendor relationships, and continuous improvement of operational performance. The Medical Staff Services Director ensures the team delivers an efficient, consistent, high-quality support to internal and external customers, continually developing and executing strategies to meet company needs. This position requires direct customer contact, displaying professionalism and excellent communication skills. The Director will develop rapport with the provider(s), contracted providers, customers, and vendors.

ESSENTIAL FUNCTIONS:

• Directs the output of a team of employees engaged in licensing, credentialing, and privileging of providers and clinicians. Analyzes and implements process improvements to enhance efficiency of licensing, credentialing, and privileging. 
• Is responsible for the workflow and affiliated software to expedite the processes of licensing, credentialing, privileging, and provider enrollment. Using continuous improvement techniques improves workflow cycle time achieving key performance results. 
• Communicates directly with customers as the subject matter expert on Avel eCare licensing, credentialing, and privileging, providing detailed information on eCare’s processes and tools. 
• Directs their team to provide the Credentials Committee completed files and completing the preliminary review of the credentialing documents for privileging applications in accordance with policies, Joint Commission standards and State and Federal laws.
• Directs the workflow of gathering data for licensing and credentialing processes and troubleshoot escalated issues as appropriate. Utilizes effective communication with department staff and keeps leadership informed of workflow and staffing issues.
• Ensures that organizations partnering with Avel eCare for credentialing data receive timely and accurate materials to review and that these materials follow regulatory and accreditation standards.
• Provides appropriate documentation of all activities within the scope of the position, allowing for follow-through on committee actions or change in policies, and confidential Clinical Provider committee actions.
• Has knowledge and facilitates compliance of The Joint Commission standards, National Committee on Quality Assurance and State and Federal regulations related to Provider licensing, credentialing, and privileging.

REQUIRED EDUCATION and/or EXPERIENCE:

• Bachelor's degree or equivalent from four-year College or technical school; or 4 - 8 years related experience and/or training; or equivalent combination of education and experience.
• Qgenda credentialing software experience preferred.

REQUIRED LICENSES/CERTIFICATES:

• Certification in process improvement methodologies preferred.

Job Tags

Similar Jobs