1710 - Director Central Verification Office & Network Operations

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Job Description Summary:

This position manages and directs the services to create seamless and efficient processes for members of the OhioHealth Clinically Integrated Network (CIN), OhioHealth medical staff and OhioHealthy Medical Plan networks. For the CIN, this includes initial and on-going delegated credentialing for CIN payers, maintenance of payer rosters of CIN members and resolution of roster defects. For medical staff, this includes assembly of privileging packets for medical staff offices and medical executive committees. For OhioHealthy, this includes assembly of packets and delegated credentialing for non-CIN providers, as contracted. This includes development of criteria, policies and procedures to enable the company to meet the credentialing and accreditation standards for the organization and continuously monitor the integrity of the provider database(s). The Director is responsible for promoting positive working relationship with internal and external customers and serving as an integral member of the leadership team of Population Health Services and Care Management.

Responsibilities And Duties:

Directs the Central Verification Office of OhioHealth. 
Directs the CIN network management team.
Responsible for annual personnel reviews.
Oversees the credentialing and recredentialing primary source verification process for all members of the Medical Staffs and Advance Practice Practitioner Staffs of the OhioHealth hospitals, Clinically Integrated Network and OhioHealthy.
Analyzes applications for completeness, looks for discrepancies/inaccuracies.
Oversight of all administrative and credentialing functions of the CIN Membership Committee.
Oversees the network management and roster management functions for the CIN, including resolution of payer-provider issues.
Serves as an integral member of the Population Health Services and Care Management leadership team.
Creates department goals in alignment with organizational strategy.
Leverages internal and external network to assist the team in acquiring necessary information and resources to achieve their goals.
As the business owner of credentialing software (currently Cactus), is responsible for the data integrity and
functionality. This includes the following: Serves as a content expert for internal and external associates and facilitates day-today operations and education of credentialing data. Overseeing upgrades/new modules/technology as it pertains to software. Overseeing data requests from credentialing software. Change requests, guideline for changes, communicating, etc. Works collaboratively with the Database Administrator for enhancements, problem resolution and enhancements.
Ensures compliance with regulatory and accreditation organizations, i.e., TJC and HFAP for hospital/ambulatory credentialing and NCQA for network credentialing which includes development and annual updates of policies and procedures.
Responsible for overseeing the hiring and training of employees both internal and external; planning, assigning, and managing work; addressing complaints and resolving problems.
Works with Medical Staff Administration Offices personnel of all system entities in achieving the OhioHealth organizational goals for provider privileging and credentialing.
Participates with regulatory surveys TJC, HFAP and NCQA as needed.
Develops, implements, monitors and/or coordinates delegated credentialing activities associated with system wide contracts PHO, PPO, and OhioHealth Physician Group.
Maintains continuous quality improvement in credentialing and recredentialing activities.
Assists in the upkeep of the OhioHealth and CIN provider directories.
Uses effective communication skills at all levels when working with associates, hospital medical
staff offices, provider groups, and medical schools/clinical training programs.
Coaching and fostering a spirit of cooperation.
Participates in departmental administrative activities as required by Population Health Services and Care Management.
Maintain confidentiality for all credentialing/recredentialing/membership issues.
Since this individual will have access to confidential provider information, a high degree of discretion and sensitivity in communications is necessary. Absolute confidentiality must be maintained.
The major duties, responsibilities and essential functions listed above are not intended to be all-inclusive of the duties, responsibilities, and essential functions to be performed by associates in this job. Associate is expected to perform other duties as requested by supervisor.

Minimum Qualifications:

Bachelor's Degree (Required)

Additional Job Description:

JOB SUMMARY

This position manages and directs the services to create seamless and efficient processes for members of the OhioHealth Clinically Integrated Network (CIN), OhioHealth medical staff and OhioHealthy Medical Plan networks.  For the CIN, this includes initial and on-going delegated credentialing for CIN payers, maintenance of payer rosters of CIN members and resolution of roster defects. For medical staff, this includes assembly of privileging packets for medical staff offices and medical executive committees. For OhioHealthy, this includes assembly of packets and delegated credentialing for non-CIN providers, as contracted. This includes development of criteria, policies and procedures to enable the company to meet the credentialing and accreditation standards for the organization and continuously monitor the integrity of the provider database(s). The Director is responsible for promoting positive working relationship with internal and external customers and serving as an integral member of the leadership team of Population Health Services and Care Management.
MINIMUM QUALIFICATIONS

Bachelor's degree
Field of Study: Credentialing
Years of experience: 3 to 5
SPECIALIZED KNOWLEDGE

Degree and three to five years related experience and/or training, or equivalent combination of educations and experience. NAMSS certification (CMSC or CPCS). General knowledge of both physician and mid-level practitioner credentialing processes including TJC and NCQA accreditation standards. Excellent organizational and leadership skills. Effective verbal and written communication skills. Customer service oriented. Experience with credentialing software system. Knowledge of Microsoft Office.
DESIRED ATTRIBUTES

Experience with credentialing software system (including Cactus) desirable. Experience or knowledge in healthcare field. Experience in data analysis and report generation utilizing Windows-based microcomputers.
BEHAVIORAL COMPETENCIES
Leadership Competencies
INFORMATION SECURITY

Maintains confidentiality of log-on password(s) and security of other authentication devices (e.g., key fobs, proximity devices, etc.).

Ensures privacy and security of information entrusted to their care.

Uses company business assets and information resources for management-approved purposes only.

Adheres to all information privacy and security policies, procedures, standards, and guidelines.

Promptly reports information security incidents to the OhioHealth Information Security Officer.
RESPONSIBILITIES AND DUTIES

Directs the Central Verification Office of OhioHealth. 

Directs the CIN network management team.

Responsible for annual personnel reviews.

Oversees the credentialing and recredentialing primary source verification process for all members of the Medical Staffs and Advance Practice Practitioner Staffs of the OhioHealth hospitals, Clinically Integrated Network and OhioHealthy.

Analyzes applications for completeness, looks for discrepancies/inaccuracies.

Oversight of all administrative and credentialing functions of the CIN Membership Committee.

Oversees the network management and roster management functions for the CIN, including resolution of payer-provider issues.

Serves as an integral member of the Population Health Services and Care Management leadership team.

Creates department goals in alignment with organizational strategy.

Leverages internal and external network to assist the team in acquiring necessary information and resources to achieve their goals.

As the business owner of credentialing software (currently Cactus), is responsible for the data integrity and

functionality. This includes the following: Serves as a content expert for internal and external associates and facilitates day-today operations and education of credentialing data. Overseeing upgrades/new modules/technology as it pertains to software. Overseeing data requests from credentialing software. Change requests, guideline for changes, communicating, etc. Works collaboratively with the Database Administrator for enhancements, problem resolution and enhancements.

Ensures compliance with regulatory and accreditation organizations, i.e., TJC and HFAP for hospital/ambulatory credentialing and NCQA for network credentialing which includes development and annual updates of policies and procedures.

Responsible for overseeing the hiring and training of employees both internal and external; planning, assigning, and managing work; addressing complaints and resolving problems.

Works with Medical Staff Administration Offices personnel of all system entities in achieving the OhioHealth organizational goals for provider privileging and credentialing.

Participates with regulatory surveys TJC, HFAP and NCQA as needed.

Develops, implements, monitors and/or coordinates delegated credentialing activities associated with system wide contracts PHO, PPO, and OhioHealth Physician Group.

Maintains continuous quality improvement in credentialing and recredentialing activities.

Assists in the upkeep of the OhioHealth and CIN provider directories.

Uses effective communication skills at all levels when working with associates, hospital medical

staff offices, provider groups, and medical schools/clinical training programs.

Coaching and fostering a spirit of cooperation.

Participates in departmental administrative activities as required by Population Health Services and Care Management.

Maintain confidentiality for all credentialing/recredentialing/membership issues.

Since this individual will have access to confidential provider information, a high degree of discretion and sensitivity in communications is necessary. Absolute confidentiality must be maintained.

The major duties, responsibilities and essential functions listed above are not intended to be all-inclusive of the duties, responsibilities, and essential functions to be performed by associates in this job. Associate is expected to perform other duties as requested by supervisor.

Work Shift:

Day

Scheduled Weekly Hours :

40

Department

Credentialing

Join us!
... if your passion is to work in a caring environment
... if you believe that learning is a life-long process
... if you strive for excellence and want to be among the best in the healthcare industry

Equal Employment Opportunity

OhioHealth is an equal opportunity employer and fully supports and maintains compliance with all state, federal, and local regulations. OhioHealth does not discriminate against associates or applicants because of race, color, genetic information, religion, sex, sexual orientation, gender identity or expression, age, ancestry, national origin, veteran status, military status, pregnancy, disability, marital status, familial status, or other characteristics protected by law. Equal employment is extended to all person in all aspects of the associate-employer relationship including recruitment, hiring, training, promotion, transfer, compensation, discipline, reduction in staff, termination, assignment of benefits, and any other term or condition of employment