The Sharp HealthCare Credentialing Director is responsible for overseeing all aspects of credentialing and re-credentialing of health care professionals for the hospitals, medical groups and health plan. This position ensures all health care professionals are credentialed accurately and timely, which includes the responsibility of maintaining current and archive information on file and within the credentialing database. The Director is responsible for system-wide compliance with applicable credentialing standards (e.g. Joint Commission, NCQA, AAAHC).
Manages the recruitment, training, scheduling, assignments and ongoing
performance of Credentialing Coordinators, Data Management and other department staff
Serves as the system-wide expert on all applicable credentialing standards (Joint Commission, NCQA, AAAHC) and State and Federal regulations
Provides credentialing related education and training to staff and others as needed
Maintains current knowledge of regulations and standards, and establishes department policies and procedures compliant with all requirements
Assists in successful accreditation/regulatory surveys and delegated credentialing audits, including presentation of requested evidence of compliance and corrective action plans
Ensure departmental compliance with HIPAA and Sharp HealthCare policies, especially those related to privacy and confidentiality
Represents the department at entity credentials committee and other requested leadership meetings.
Serves as liaison to entity Medical Staff Offices, Medical Executive Committees, Chiefs of Staff, health plan, medical groups, Chief Medical Officers and other physician leadership
Provides support and service recovery to physicians, providers and other stakeholders
Represents Share HealthCare at California Association of Medical Staff Services (CAMSS) meetings and other applicable professional forums
Credentialing & Verification Functions:
Directs the timely and accurate completion of health care professionals credentialing and re-credentialing applications
Directs primary source verification and collection of documentation for licensing, board certifications, proof of professional liability insurance, National Practitioner Data Bank (NPDB) and/or other sources as required based on Joint Commission and NCQA standards, health plan requirements and credentialing policies
Ensures the accurate collection and documentation of all required renewal certifications (expirables) within the required time frame
Cross trains within department to support credentialing operations and provide back-up support for key functions as needed
Ensures appropriate notification to hospitals, health plans and medical groups of provider demographic changes as well as required documentation in the credentialing database
Directs the processing of provider network terminations
Collects/receives/audits disciplinary, OIG, and other reports as required (i.e. State Licensing Board, NPDB and other sanctioning bodies); takes appropriate action
Provides consistent and timely follow-up on all outstanding credentialing/re-credentialing files, escalating issues to appropriate leadership when necessary
Data Management & Performance Improvement:
Establishes reliable file collection, scanning, data capture and data entry procedures into the credentialing database
Monitors the timeliness, completeness and accuracy of data collection and entry processes
Prepares and presents reports on key performance measures to accountable leadership and committees
Prepares credential committee reports, adverse action documentation and other required reports as requested
Applies performance improvement and lean principles to continually evaluate and improve department performance
Skills and Qualifications:
Minimum of three (3) years of supervisory or management level experience in credentialing required.
Minimum of five (5) years credentialing experience required.
Expert knowledge of credentialing accreditation regulations and standards required.
Experience managing medical staff software implementation and upgrades (especially CACTUS) preferred.
Medical group and health plan experience preferred
Must be able to operate applicable technology, including computer, Microsoft software, fax, copier, scanner and telephone, etc.
Must demonstrate exceptional communication skills, listening effectively and asking questions when clarification is needed.
Ability to plan, assign, supervise and evaluate the work of others, and to monitor goals, objectives, deadlines and priorities.
Demonstrate accuracy, organizational and problem-solving skills. Ability to monitor work unit performance, identify opportunities, and improve processes to promote quality and safety.
Ability to assume responsibility and exercise good judgement in making decisions within the scope of authority of the position.
Must demonstrate and promote a positive team-oriented environment.
Must be able to stay focused and concentrate under reasonable levels of stress and distraction.
Must possess ability to manage change, delays, or unexpected events appropriately.
Sharp HealthCare is an Equal Opportunity/Affirmative Action Employer, we celebrate our employees’ differences. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, disability, gender, gender identity, transgender status, sexual orientation, protected veteran status, among other things, or status as a qualified individual with disability.
Internal Number: 111165
About Sharp Healthcare
At Sharp HealthCare, it is our mission to improve the health of everyone we serve. And as San Diego's leading health care provider, we're proud to touch the lives of more individuals in our community than any other health care system.
Sharp is not for profit, but for people, which means all of our resources are dedicated to delivering the highest quality patient-centered care, the latest medical technology and superior service. Every day, our more than 2,700 affiliated physicians and 18,000 employees work to provide our patients and their families with the extraordinary level of care that we call The Sharp Experience.
And with four acute-care hospitals, three specialty hospitals, three affiliated medical groups and a full spectrum of other facilities and services, Sharp makes it easy to get the care you need close to home.