AVP, Clinical Onboarding Credentialing & Provider Enrollment

Overview

 

 

This position is responsible for the supervision of Credentialing, Provider Enrollment, and Clinical Onboarding departments. The Associate Vice President is accountable for performance outcomes and overseeing the individual department's effectiveness, assigning responsibilities for tracking the progress of all health providers and lending support as appropriate. The Associate Vice President should establish timeline targets and monitor the progress of provider onboarding, credentialing, and provider enrollment. Establish that the health provider list is accurate, and monitor utilization, financial impacts, and other vital metrics. Provide support for the physician credential assignments. In addition, the Associate Vice President is accountable for successfully delivering team activities, including regulatory requirements according to time/scope and budget constraints.

Responsibilities

• Establishes objectives and annual goals in conjunction with the Executive team.
• Direct the overall management of Clinical Onboarding, Credentialing and Provider Enrollment departments.
• Interview prospective employees, coordinate orientation, manage employee performance, counsel employee, and implement corrective action, schedule staff and time off requests.
• Monitors the Onboarding process and supports the department to meet department objectives.
• Ensure that Provider On-Boarding Team is appropriately communicating with providers and that any follow up occurs in a timely manner.
• Lead on-boarding meetings and work to resolve on-boarding issues that arise and offer resolution.
• Ensures a complete review of all completed Provider information for completeness prior to forwarding to Provider Enrollment Team or 3rd party vendor for action.
• Manage the Salesforce database on the on-boarding side. Ensure data is comprehensive, updated, and accurate always.
• Develop and present escalation grid to Leadership for any provider that is in danger of not being credentialed by their start date.
• Assist with escalations for answering provider questions about the hospital and payer credentialing process.
• When necessary, meet with operational leaders and/or market presidents to facilitate completion of credentialing paperwork.
• Supervise and directs medical credential and licensure activities to ensure accuracy and compliance with defined schedules and policies/regulations.
• Oversee and manage the primary source process and participate in credentialing meetings.
• Manage communications with Patient Accounts, Information Management, Managed Care, Risk Management as it related to all license, privilege, and health plan enrollment issues, including malpractice insurance, provider group/pin numbers, new health plan contracts.
• Support acquisitions as related to gathering of appropriate provider data, review due diligence documents and documents all credentialing in appropriate files/records.
• Develop and maintain all policies and procedures for each department processes and revise as needed. Researches and summarizes best practices in field and innovate and implement changes as needed.
• Once provider start date is assigned, work with the Physician Contracting, CVO, Provider Enrollment, and hospitals to ensure that start dates continue to be attainable.
• Manage Clinical Onboarding, Credentialing, and Provider Enrollment department budgets within allowed established company guidelines.
• Perform other duties as assigned.

Qualifications

• Bachelor’s degree or equivalent work experience is required. Masters strongly preferred.
• Graduate degree in business administration (MBA), nursing (MSN), or public administration (MPA) preferred.
• Minimum of ten (10) or more years of current progressive, operational experience in HEDIS, quality management, quality improvement, risk management, and/or utilization management in a managed care setting
• Seven (7) years of strong senior level leadership/ management experience is required.
• Demonstrated management of multiple regulatory and accreditation areas covering a broad range of populations and states.
• Previous related healthcare experience: knowledge of credentialing standards, which includes state and federal regulations as well as hospital regulations and NCQA standards. 
• Strong organizational and prioritization skills to effectively coordinate credentialing and promote patient care activities.
• Excellent organization and time management skills with the ability to handle multiple priorities successfully.
• Excellent interpersonal skills.
• Ability to identify and define complex problems and develop and implement solutions.
• Experience with and thorough understanding of medical billing pro