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Director Credentialing

Crossroads Treatment Centers Minneapolis, MN

  • Expired: January 21, 2021. Applications are no longer accepted.

Crossroads Treatment Centers was founded on May 5, 2005 to serve a patient population with opioid addiction. Since its founding in 2005, the company has grown rapidly and now includes 90+ treatment centers in 10 states. Each member of the Crossroads team specializes in an area that supports the recovery of over 26,000 patients. Crossroads' clinical staff includes physicians, pharmacists, counselors, nurses, and other service coordinators. Along with medication management, our staff works closely with each patient to create an individualized treatment plan aimed at building recovery and relapse prevention skills.

Position location: Greenville, SC

Position Summary: Under minimal supervision oversees credentialing/privileging program to assure credentialing processes are in compliance with professional standards and state and federal regulatory requirements; health plan delegation for credentialing is maintained, and corporate growth initiatives are supported. This individual and team play a key role in linking operations and systems to ensure these functions are in sync with corporate growth initiatives.

Essential Duties & Responsibilities: The duties listed below are intended only as illustrations of the various types of work that may be performed. The omission of specific statements of duties does not exclude them from the position if the work is similar, related or a logical assignment.

40% Credentialing and Privileging

  • Ensure credentialing processes are in compliance with professional standards, bylaws, state and federal regulatory requirements with such organizations such as the National Committee for Quality Assurance (NCQA), Centers for Medicare and Medicaid (CMS), Utilization Review Accreditation Commission (URAC).
  • Develops credentialing and privileging policies and procedures. Reviews policies to assure incorporation of regulatory changes; and recommends changes, revisions and enhancements as needed in accordance with best practices.
  • Oversees and supports the day to day operations of Credential/Privileging processes.
  • Facilitates the implementation of credentialing committee recommendations and follow-through.
  • Oversees and maintains credentialing database; generates reports and prepares audits as requested.
  • Function as primary contact for all internal and external inquiries regarding Credentialing and Privileging, and potential and/or existing practitioners regarding credentialing.
  • Act as a liaison between department and clinical areas
  • Identifies opportunities to improve processes and systems.

20% Strategic Planning

  • Advises organization leadership on changing regulatory requirements and implications for our business model.
  • Reviews and responsible for providing oversight and management of department budgeting and forecasting, goals, and initiatives.
  • Provides feedback regarding provider licensing, privileging, and regulatory planning for all new sites and acquisitions.

20% Department Management

  • Provides day-to-day supervision of staff with ongoing feedback and evaluation of work performed, including hiring, terminations, annual performance reviews and staffing needs.
  • Acts as a role model, and serve as a leader and resource for staff.
  • Provides training of new employees and cross-training to provide coverage when staff is absent or work load demands
  • Serves as facilitator and essential link between health plans to ensure patient access and claim(s) reimbursement
  • Oversees for the submission of provider information to health plans for inclusion in health plan networks.
  • Oversees the notification to health plans of provider terminations and reassignment of membership when applicable.
  • Oversee the notification to health plans of provider information/demographical updates and changes as well as practitioner panel changes.
  • Responsible for monthly, quarterly and semi-annual reporting of credentialing activities to health plans.

Knowledge, Skills & Abilities:

  • Knowledge: Regulatory requirements of CMS, National Committee for Quality Assurance and the Utilization Review Accreditation Commission. Credentialing and Privileging best practices.
  • Skills: Proficient in keyboard and computer skills including MS Word, Excel and credentialing software
  • Abilities: Ability to work independently and interact effectively in multi-cultural professional environment. Attention to detail, and accuracy.

Minimum Qualifications:

  • Education: Bachelor's degree in Business or related field, or equivalent experience.
  • Experience: Minimum of three to five years of supervisory experience. Minimum of five years in a Credentialing/Medical Staff environment.
  • Excellent working knowledge of PECOS, CAQH and NPI Data Base

Employment Type: FULL_TIME

Crossroads Treatment Centers

Address

Minneapolis, MN
USA
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