Department: CREDENTIALING & VERIFICATION
Status: Full Time
Title: Credential Verification Manager
Summary:
We are seeking a detail-oriented Credential Verification Manager to join our team. In this role, you will manage the Credentialing Verification Office (CVO), Team Member Health Plan, and Provider Enrollment Teams who all provide various aspects of credentialing verifications for providers to see patients, obtain payments for services, and meet all regulatory guidelines.
The CVO team provides primary source verifications for all initial credentialing applications and re-credentialing across all sites for Orlando Health contracted physicians, allied health professionals, the clinically integrated network and other staff as assigned. The Team Member Health Plan team credentials all providers within OH and the CIN to ensure compliance with our health plan and acting as delegation for our payer contracts. The Provider Enrollment team ensures providers are enrolled with managed care plans and governmental payors as applicable. Role is additionally responsible for ensuring Orlando Health compliance with regulatory and accreditation standards, as well as state and federal regulations impacting Medicare and Medicaid, and managed care plan policies and protocols.
Forbes has named Orlando Health as one of America's Best-In-State Employers. Orlando Health is committed to providing you with benefits that go beyond the expected, with career-growing FREE education programs and well-being services to support you and your family through every stage of life. We begin your benefits on day one and offer flexibility wherever possible, so that you can be present for your passions.
“Orlando Health Is Your Best Place to Work” is not just something we say, it’s our promise to you.”
Orlando Health proudly embraces and honors the individuality of our team members. By sharing different ideas and perspectives and working together as a team, we are better able to relate to, care for and authentically serve our patients and families who make up the collective populations in our community. So, no matter who you are, what you believe or how you express yourself, you are welcome here.
ORLANDO HEALTH - BENEFITS & PERKS:
Competitive Pay
- Evening, nights, and weekend shift differentials offered for qualifying positions.
All Inclusive Benefits (start day one)
- Student loan repayment, tuition reimbursement, FREE college education programs, retirement savings, paid paternity leave, fertility benefits, back up elder and childcare, pet insurance, PTO/Holidays, and more for full time and part time employees.
Forbes Recognizes Orlando Health as a Best-In-State Employer
- Forbes has named Orlando Health as one of America's Best-In-State Employers for 2021. Orlando Health is the top healthcare organization in the Metro Orlando area to make the prestigious list. "We are proud to be named once again as a best place to work," said Karen Frenier, VP (HR). "This achievement reflects our positive culture and efforts to ensure that all team members feel respected, supported and valued.
Employee-centric
- Orlando Health has been selected as one of the “Best Places to Work in Healthcare” by Modern Healthcare.
- Manages the primary source verifications, recredentialing functions and customer services aspect of the CVO, taking the ownership previously under Medical Staff Services to align under new CVO.
- Lead CVO in customer service’s needs, building team of subject matter experts, and enhancing Orlando Health onboarding turnaround times to better serve our teams.
- Accountable for Service Line Agreements with stakeholders of the CVO, including Medical Staff Services, site Credentialing Committees, and local Medical Staff Offices.
- Accountable for Key Performance Indicators associated with team performance and turnaround times.
- Acts as primary source of truth for data feeding all downstream systems, accountable for data integrity.
- Participates in Provider Data Governance Council in role of data steward.
- Direct responsibility for all provider follow up, including external and internal media pages.
- Manages the accurate and timely credentialing of Orlando Health employed and contracted physicians, allied health professional staff, and hospital facilities with managed care plans and governmental payors; including but not limited to Medicare, Medicaid, Tricare, Regional Peri-Natal Intensive Care Center (RPICC), Children’s Medical Services (CMS).
- Develop full understanding of and expertise in National Committee for Quality Assurance (NCQA) credentialing standards and ensures that all Orlando Health credentialing processes meet those criteria.
- Maintains current knowledge of governmental compliance, regulations, policies, and protocols and assesses impact on credentialing processes. Develops and implements processes to ensure timely and accurate compliance with all governmental entities affecting credentialing and ultimately physician and professional staff revenue.
- Develops, implements, and manages current managed care credentialing processes.
- Identifies and resolves departmental issues related to credentialing and develops performance improvement plans as necessary.
- Researches, develops, and manages credentialing action plans for new system endeavors related to employed physician practices and/or changes associated with state and federal regulations impacting Medicare and Medicaid credentialing.
- Prepares status reports and recommendations for Director of Managed Systems.
- Manages, assigns, prioritizes, and distributes work load of Credentialing Specialists.
- Facilitates presentation of monthly credentialing files to Orlando Health Credentialing Committee.
- Actively participates on other physician committees and task forces, as necessary.
- Handles escalated credentialing items requiring attention and notifies Department Director of such.
- Responsible for mitigating financial risk to the organization by managing to proper credentialing policies and procedures and ensuring timely and accurate credentialing of all Orlando Health entities.
- Interacts and communicates with physicians, administrators, and numerous departments both internal and external to Orlando Health.
- Develops and maintains strong business relationships with managed care plans, and Medicare and Medicaid governmental state of Florida and federal entities to facilitate timely credentialing.
- Manages physician credentialing database and takes steps necessary to ensure integrity of the data maintained.
- Implement and manage credentialing system, MD Staff, and applicable applications, to ensure system is being used to its’ maximum potential.
- Addresses and resolves internal and external issues related to physician credentialing.
- Supervises credentialing team and administers coaching plans, counseling and guidance to all team members.
- Manages various personnel functions including hiring, work assignments, coaching plans, and disciplinary actions.
- Reviews team performance, effects changes as needed to improve service.
- Handles training process of new credentialing team members.
- Ensures credentialing department maintains confidentiality of all credentialing specific information.
- Maintains reasonably regular, punctual attendance consistent with Orlando Health policies, the ADA, FMLA and other federal, state, and local standards.
- Maintains compliance with all Orlando Health policies and procedures
Other Related Functions:
- Development of timelines, action plans and reporting.
- Demonstrates knowledge of group dynamics and collaborative processes.
- Demonstrates project management skills and team coordination skills to include organization and empowerment.
- Works as a team player in facilitating efficient and effective assistance to team members of the Central Billing Office and Orlando Health physician practices.
- Assists physicians and others as needed with all matters relative to CVO, Managed Care, Medicare, and Medicaid credentialing.
- Utilizes problem solving techniques to create a proactive environment.
- Assumes responsibility for professional growth and development.
- High School Diploma.
Experience:
- Seven (7) year’s applicable credentialing experience. A Bachelor’s degree may substitute for 3 years of the required experience.
