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CVO Senior Credentials Manager

Job ID: 216241
Category: Human Resources
Work Type: FT
Location: Philadelphia, PA, United States
Work Schedule: M-F; day shift | Remote

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Description

Penn Medicine is dedicated to our tripartite mission of providing the highest level of care to patients, conducting innovative research, and educating future leaders in the field of medicine. Working for this leading academic medical center means collaboration with top clinical, technical and business professionals across all disciplines.

Today at Penn Medicine, someone will make a breakthrough. Someone will heal a heart, deliver hopeful news, and give comfort and reassurance. Our employees shape our future each day. Are you living your life's work?

CVO Senior Credentials Manager

This is a full-time remote position.

Job Summary:

  • Experienced leader responsible for the enterprise-wide credentialing operations of the Penn Medicine Office of Medical Affairs that includes an internal NCQA certified Credentials Verification Organization (CVO). The Penn Medicine CVO completes and maintains credentials and privileges of 10,000 providers. As the CVO Senior Manager, you will collaborate with and provide data to health system operational leaders that include the Senior Manager of CVO Enrollment who has accountability for over 5,500 billable and/or employed providers, each participating in over 60 payer contracts. The Penn Medicine CVO performs delegated credentialing for employed/billable providers that directly impacts Penn Medicine revenue stream. The CVO conducts all credentialing activities for all Penn Medicine hospitals and their provider-based sites, as well as Penn Medicine's licensed ambulatory surgical facilities.

  • A strong knowledge of regulatory body requirements that include The Joint Commission (TJC), Department of Health (DoH), Centers for Medicare & Medicaid Services (CMS), and the National Committee on Quality Assurance (NCQA) which supports the Penn Medicine health system’s continued excellence. Accountable for the direction and management of the biennial CVO NCQA survey.

  • Solution driven leader with focus on streamlined processes and the provider experience. Reporting to the Associate Vice President, the CVO Senior Manager will have a key role in the development and support of system strategic plan, department goals, initiatives, policy and procedures, and budget. NAMSS CPCS certification is strongly suggested with completion of additional CPMSM certification within two years of employment. 

Responsibilities:

  • Directly manages CVO Credentialing Operations Supervisor/Manager and all credentials staff not reporting directly to the CVO Credentialing Operations Supervisor/Manager; includes workflow design, work allocation, training, promotion, enforcement of internal procedures and controls, and problem resolution; evaluates performance and makes recommendations for personnel actions; motivates employees to achieve peak productivity and performance.
  • Holds primary responsibility for CVO’s ongoing NCQA certification including but not limited to leading the biannual survey effort. Supports (Sr) Compliance Analyst with regulatory surveys/audits, and ensures compliance with TJC, DoH, CMS & NCQA standards.
  • Manages and reports operational metrics. Monitors and manages turnaround times for processing of credentials applications and has overall accountability for focus on delivery of a high quality product, with the greatest efficiency, in the least amount of time. Accountabilities include but are not limited to: 
  • 1. Overall management of the application/verification and evaluation management in accordance with the procedures detailed in the CVO Operating Manual;
  • 2. Coordinate with clients as they set up and credential new practices and providers;
  • 3. Ensure expirables (licenses, DEAs, malpractice coverage, etc.) are kept current and ongoing monitoring is conducted, and status is reported to clients;
  • 4. Identify and minimize data discrepancies passed to payer enrollment so that the data are complete, correct and timely in order to optimize the Revenue Cycle.
  • Ensure compliance with accrediting organization requirements, each of the Penn Medicine medical staff bylaws & accompanying manuals and credentials-related policies, develop and review CVO Operating policies and procedures, and delegated credentialing policies and procedures; develops, recommends, and/or implements changes, revisions, and enhancements as appropriate.
  • Responsible for maintaining strong customer relationships with client leaders and staff at Penn Medicine hospitals, ensuring that they understand their role in the credentialing process.
  • Leads credentialing team in designing credentialing and privileging processes and in prioritizing and assigning resources devoted to process improvement, ensuring an appropriate level of quality control over credentialing and privileging work product.
  • Supports the AVP in drafting the annual Office of Medical Affairs strategic plan/goals and budgets and proposes updates as necessary; manages strategic initiatives in order to keep on time and on budget, and provides AVP with regular updates.
  • Works with OMA Managers to ensure that all CVO and hospital MSO staff have the necessary and appropriate training to be successful in their work.
  • Serves as senior credentialing representative to clients, both within and outside of Penn Medicine.
  • 1. Ensures that OMA is providing excellent service to its customers;
  • 2. Primarily responsible for credentialing aspects of CVO integration projects;
  • 3. Primary attendee of CVO Users Group and other operational meetings;
  • 4. Primary credentialing participant in payer contract negotiation and contract implementation;
  • Performs duties in accordance with Penn Medicine and entity values, policies, and procedures.
  • Other duties as assigned to support the unit, department, entity, and health system organization.

Credentials:

  • NAMSS certification (CPCS and/or CPMSM)- within one year of employment (Preferred).

Education or Equivalent Experience:

  • Bachelor's degree, preferably in business, information management, health administration or related field (Required).
  • 7+ years of experience with hospital credentialing and/or ‘delegated credentialing experience’ (Required).
  • Master's degree, preferably in business, information management, health administration, or related field (Preferred).

Skills & Abilities:

  • Must have the ability to maintain information in a confidential manner in accordance with all regulatory requirements.
  • Must be able to think critically and generate/analyze information and instruct staff to do the same.
  • Must be able to work effectively as a team leader, build effective teams, and drive employee engagement.
  • Must be able to meet deadlines and conduct operations within budget.
  • Must be able to exercise good judgment when escalating issues.
  • Strong verbal and written communication skills to enable sufficient, timely, and effective communications with providers and external contacts.
  • Proficient in computers and computer software, including but not limited to, database management, spreadsheet and word processing applications.
  • Proficiency in Microsoft Office Suite.
We believe that the best care for our patients starts with the best care for our employees. Our employee benefits programs help our employees get healthy and stay healthy. We offer a comprehensive compensation and benefits program that includes one of the finest prepaid tuition assistance programs in the region. Penn Medicine employees are actively engaged and committed to our mission. Together we will continue to make medical advances that help people live longer, healthier lives.

Live Your Life's Work

We are an Equal Opportunity and Affirmative Action employer. Candidates are considered for employment without regard to race, ethnicity, color, sex, sexual orientation, gender identity, religion, national origin, ancestry, age, disability, marital status, familial status, genetic information, domestic or sexual violence victim status, citizenship status, military status, status as a protected veteran or any other status protected by applicable law.

   Current UPHS employees must apply HERE
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