Healthcare Operations - Credentialing Manager
Orange Park , Florida
April 07, 2017
The Manager of Credentialing at Parallon's Shared Services should possess a strong background in data analysis and credentialing. This includes proactively identifying issues, coordinating issue resolution, and monitoring events to determine educational opportunities. This also involves monitoring performance to identify best practices and working with the AVP of Credentialing to implement best practices across the operation. Additionally, this includes developing applicable credentialing policies and procedures and providing input. This individual will play a key role in linking operations and systems (working closely with IT&S) to ensure these functions are in sync with compliance parameters. This individual is a liaison between the Shared Services division, applicable HCA Corporate Departments (e.g., Legal, Quality Standards, and Information Technology & Services), and Credentialing Processing Center (CPC) personnel regarding credentialing issues. They will participate in Internal Audit and Program development, Resolution of issues, and other functions related to compliance in the CPC to address and identify issues. This individual must demonstrate strong commitment to stakeholder relationships by taking ownership of issues and facilitating effective outcomes in a timely manner.

• Possesses a detailed understanding of credentialing operations and credentialing systems
• Stays abreast of and communicates effectively in regards to federal and multi-state regulatory requirements, emerging industry trends and company policies
• Proactively identifies and researches potential payroll issues and recommends courses of action
• Conducts investigations resulting from communicated issues
• Performs onsite operational assessments of CPC operations, makes recommendations for improvements and ensures implementation of action plans
• Provides applicable documentation; which may include regulations, to support recommended courses of action
• Develops best practice documentation and implementation plans
• Works with Internal Audit to develop and enhance audit plans and procedures
• Reviews internal and external audit reports and investigation reports relating to the CPC and ensures appropriate corrective and preventative actions have been taken
• Develops periodic communication tool for CPC distribution and conducts periodic conference calls to discuss issues and opportunities for improvement
• Keeps leadership informed of the status of issues at the CPC via a specific reporting mechanism
• Acts as a resource to CPC and division/facility leadership
• Actively communicates with divisions, facilities and corporate stakeholders related to any credentialing issues or initiatives
• Works with AVP of Credentialing to ensure any new policies / processes are compliant with all company / regulatory requirements
• Contributes to training and education materials for use in CPC training; presents training materials - as applicable
• Participates on corporate committees, work groups and task forces as needed
• Assures colleagues understand they may raise concerns or report suspected violations of the Code, of Policies and Procedures, or of law or regulations to a supervisor, to any member of local management, to the ECO, or to the Corporate Ethics Line without fear of retaliation
• Maintains confidentiality with all payroll information
• Sets appropriate example for staff by maintaining a positive attitude regarding customers, leadership, and the work at hand
• Practice and adhere to the "Code of Conduct" philosophy and "Mission and Value Statement"
• Other duties as assigned by the AVP
• Organization - proactively prioritizes needs and effectively manages resources
• Communication - communicates clearly and concisely with staff, leadership and customers
• Leadership - guides assigned individuals and groups toward desired outcomes, setting high performance standards and delivering leading quality services
• Customer orientation - establishes and maintains long-term customer relationships, building trust and respect by consistently meeting and exceeding expectations
• Policies & Procedures - articulates knowledge and understanding of organizational policies, procedures and systems
• PC skills - demonstrates proficiency in Microsoft Office applications and others as required; ability to quickly learn new PC skills
• Project Management - assesses work activities and allocates resources appropriately, applies tools and processes to identify and communicate project goals, schedules, responsibilities, progress and performance
• Strong Interpersonal Skills - builds strong relationships with diverse groups, encouraging accomplishment of mutually established goals
• Technical Expertise - knowledge of credentialing and data analysis

• Associate Degree or equivalent combination of education and experience required. Bachelor Degree strongly preferred.
• NAMSS CPCS (Certified Provider Credentialing Specialist) Certification preferred EXPERIENCE
• Minimum of 3 years experience in credentialing or data analysis (i.e., healthcare facility, managed care setting, credentials verification organization, or medical staff office)
• Experience Credentialing Accreditation by Joint Commission or National Committee for Quality Assurance preferred.
• Demonstrated working knowledge of the health care and credentialing industry, including medical legal issues and laws, regulatory agencies, and other national standards.



A little about us:
HCA is the nation’s leading private provider of healthcare services. Comprised of locally managed facilities which include 230,000 employees at over 160 hospitals, over 120 surgery centers and 100 urgent care facilities in 20 states and the United Kingdom

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