The System Director, Credentialing is responsible for ensuring physicians, clinicians, and other providers are credentialed, appointed and privileged with health plans, hospital medical staff's, other patient care facilities, physician organizations and other network arrangements such as a clinical integrated network ("CIN") and accountable care organization ("ACO").Through numerous entry points throughout the system, this position is responsible for establishing and then leading/managing the standards, governance, process-flows, resource allocation and IT system access to the system credentialing software tool.Additionally, this position is accountable for maintaining up-to-date data for each physician, clinician, and provider in the database and online system, including data and reports used for payer roster management.This includes initial credentialing and re-credentialing as required by regulatory bodies, either every two years, three years, or other date spans as required.Demographic data is to be gathered and stored in a standardized manner, including proof of timely renewal of licenses and certifications. This position is accountable, on behalf of CHRISTUS Health, for meeting and maintaining needed accreditation standards including NCQA, JCAHO and URAC as required by contractual and regulatory requirements.
Lastly, this position will also be accountable to start and manage a Credentialing Verification Organization ("CVO") for CHRISTUS Health, allowing delegated arrangements to be put into place on behalf of employed physicians, CIN, ACO, PHO, and all networks for CHRISTUS Health.
Bachelor's Degree; equivalent experience may be considered in lieu of Bachelor's Degree.
Minimum 10 years of experience in credentialing and payer roster management.
Extensive knowledge and experience in hospital medical staff and managed care credentialing, including delegate credentialing.
Minimum 5 years of experience in management / direct supervision of staff.
Excellent communication skills
Computer skills including significant knowledge of Word, Excel, and PowerPoint
Working knowledge of industry requirements for NCQA, URAC, and JCAHO
CHRISTUS HEALTH is an international Catholic, faith-based, not-for-profit health system comprised of almost more than 600 services and facilities, including more than 60 hospitals and long-term care facilities, 350 clinics and outpatient centers, and dozens of other health ministries and ventures. CHRISTUS operates in 6 U.S. states, Colombia, Chile and 6 states in Mexico. To support our health care ministry, CHRISTUS Health employs approximately 45,000 Associates and has more than 15,000 physicians on medical staffs who provide care and support for patients. CHRISTUS Health is listed among the top ten largest Catholic health systems in the United States.