Senior Director Provider Credentialing

Senior Director of Provider Credentialing

The Senior Director of Provider Credentialing is a key leadership role within MedStar Health, responsible for overseeing the credentialing and privileging processes for all healthcare providers. This position ensures that all providers meet the necessary standards and regulatory requirements to deliver safe and effective patient care. The Senior Director works closely with various stakeholders, including medical staff, administration, and external regulatory bodies, to maintain a high level of compliance and operational efficiency. Additionally, this position oversees all accreditation activities for the National Committee for Quality Assurance (NCQA), Joint Commission (JCAHO), and Department of Health-related visits.

Primary Duties and Responsibilities

• Develop and implement strategic plans for the credentialing department to align with the organization's goals, while collaborating with senior leadership to develop policies and procedures that support organizational objectives.
• Lead, mentor, and manage the credentialing team, fostering a culture of excellence and continuous improvement. This includes the management of the Central Verification Office's (CVO) workforce to include interviewing, hiring, scheduling, coaching, counseling, and evaluating all associates and supporting contractors.
• Oversee the entire credentialing and privileging process for all healthcare providers, ensuring compliance and adherence to all regulatory requirements established by state, federal, and accrediting body standards, including, but not limited to, those set forth by The Joint Commission, NCQA, CMS, and other relevant bodies.
• Ensure timely and accurate processing of initial credentialing, re-credentialing, and privileging applications and maintains up-to-date records and documentation for all credentialed providers.
• Conduct regular audits of credentialing files and processes to identify and address any deficiencies; implement corrective actions and process improvements as needed to maintain high standards of quality and compliance.
• Serve as the primary point of contact for internal and external stakeholders regarding credentialing matters by building and maintaining effective relationships with medical staff, department heads, and external agencies.
• Facilitate communication and coordination between the credentialing department and other organizational units.
• Utilize credentialing software and databases to manage provider information and ensure data integrity; identify opportunities to audit these databases to ensure data integrity.
• Develop requirements for the data and analytics strategy to drive continuous improvement throughout CVO operations and support data-driven decision-making; provide insights and recommendations to senior leadership based on data analysis and industry trends.
• Responsible for all aspects of managing the program-of-record credentialing database (e.g., CredentialStream), including vendor coordination, granting user access, ensuring associates use the database, and supporting MedStar Health leaders requesting system interface to feed related systems (e.g., physician billing services).
• Serves as the liaison for physician referral functions, provider directory website, and all related databases utilizing the specified program-of-record database as the single-source of truth for provider information.
• In conjunction with MSO leadership, provides support to Peer Review Committees as required, including, but not limited to, researching literature, data collection and formal presentation, and serving as a subject matter expert for the credential process.
• Serves as the primary liaison to all MedStar Health entity-level Medical Staff Offices and Vice Presidents of Medical Affairs by providing insight into credentialing services, delineation of privileges initiatives, and other related activities.
• In conjunction with managers for credentialing services, assists in managing systemwide credentialing committee(s) processes by ensuring submitted files are complete and comply with credentialing standards; serves as a subject matter expert regarding for all physician file reviews.
• In conjunction with MSO leadership, serves as the primary liaison with MedStar Health public affairs and marketing functions to provide accurate data and reports supporting the physician referral directory and physician scheduling programs on MedStar Health and entity websites.
• Participates in multi-disciplinary quality improvement teams and represents the CVO department in entity-level and community outreach efforts.

Minimum Qualifications

Education

Experience

Licenses and Certifications

Knowledge, Skills, and Abilities

This position has a hiring range of $114,004 - $219,960