DaVita Manager, Provider Enrollment (Credentialing) in ST. PETERSBURG, Florida

Manager, Provider Enrollment (Credentialing)

Description

DaVitaMedical Group manages and operates medical groups and affiliated physiciannetworks in California, Nevada, New Mexico, Florida, Colorado and Washington inits pursuit to deliver excellent-quality health care in a dignified andcompassionate manner. As of June 30, 2016 DaVita Medical Group (formerlyHealthCare Partners) provided integrated care management for approximately760,000 patients. DaVita Medical Group’s leadership development initiatives andsocial responsibility efforts have been recognized by Fortune, ModernHealthcare, Newsweek and WorldBlu.

Weare committed to bringing the benefits of coordinated care to our patients andto taking a leading role in the transformation of the national healthcaredelivery system to assure quality, access, and affordable care for all.

Weare committed to bringing the benefits of coordinated care to our patients andto taking a leading role in the transformation of the national healthcaredelivery system to assure quality, access, and affordable care for all.

Ifyou're looking to make a difference with a large, financially stable,well-recognized medical group, DaVita HealthCare Partners may be the employerfor you!

Weare seeking a Manager of Provider Enrollment(Credentialing) to join our talented team!

Overview:

TheManager of Provider Enrollment (Credentialing) is responsible for establishingand maintaining strong and mutually beneficial relationships with allclinicians, participating health plans, hospitals and nursing facilities. Work in cooperation with various Clinicians, Managers,Directors and VPs to facilitate health plan and hospital credentialingprocesses and system assignment

Essential Functions:

  • Consistently exhibitsbehavior and communication skills that demonstrate DaVita Medical Group’scommitment to superior customer service, including quality, care and concernwith each and every internal and external customer.

  • Reports to the Directorof Clinician Recruitment and Credentialing and participates in frequentmeetings to provide updates and reports to key stakeholders

  • Assures that DMGscredentialing program is compliant with health plan, state and federalregulations including Medicare, Medicaid and NCQA and other accrediting bodies.

  • Manages quality controlof content and completeness of clinician data within the credentialing/providerenrollment arena.

  • Oversees elementverifications for credentialing files including license, DEA, boardcertification, training, malpractice insurance, FSMB and NPDB queries.Manages contracts with these entities toperform primary source verifications.

  • Oversees HospitalPrivileging process for employed clinicians.

  • Participates andsupports the various external accreditation programs (IMQ, AAAHC) withstandards that apply to Credentialing.

  • Performs regularcommunication with health plans including quarterly credentialing statusreports, frequent calls, weekly communication to stakeholders etc.

  • Works with variousdepartments in the oversight of Medicare and other health plan applications forclinicians.

  • Works with multipledepartments to ensure that incoming and outgoing information is accurate andappropriate.

  • Oversees and updates thecredentialing process manual.

  • Coordinates and overseesCredentialing Committees/meetings including managing agendas, attendees andminutes.

  • Acts as administratorfor SyMed (credentialing software system) which includes assigning user namesand passwords, setting up access security, working with IT for upgrades tosystem and managing contract with vendor.

  • Writes reports in SyMedfor use on an ad hoc and regular basis.

  • Trains staff on use ofSyMed and assists staff with technical training and resolution of issues.

  • Creates and managesdepartment budget.

  • Trains, supervises andevaluates performance of credentialing staff.

  • Uses, protects, anddiscloses DMG patients’ protected health information (PHI) only in accordancewith Health Insurance Portability and Accountability Act (HIPAA) standards.

  • Performs additionalduties as assigned.

Qualifications

Education:

  • One or two years of post-highschool education or a degree from a two-year college.

  • Bachelor’s Degree in ahealth related field preferred or equivalent experience considered.

Experience :

Minimum:

  • Seven years ofexperience in the medical field (HMO experience a plus)

  • Four years’ experience inmanagement/supervisory role, managing at least 3 team members.

  • Experience in ProviderEnrollment essential

  • CPCS or CPCMcertification a plus

  • In-depth understandingof MCR and MCD provider enrollment

Knowledge, Skills, and Abilities:

  • Computer literate.

  • Ability to read, write,speak and understand the English language fluently

  • Ability to travelperiodically

  • Knowledge of providerenrollment, health plans, credentialing and medical terminology.

  • Knowledge of MCR and MCD

  • Leadership experience a must

  • Knowledge of data entry,word processing, database management and other menu-driven computerapplications.

  • Ability to interact withphysicians and employees at all levels of the organization.

  • Ability to adapt toorganizational changes and work within an environment of constant evolution andchange.

  • LEAN experience a plus

  • Excellent organizationaland multi-talking skills.

Primary Location FL-ST. PETERSBURG - 33702

Req ID: 308266