Job Summary

Supervises the VMG CAQH Credentialing Coordinators and Specialists to ensure compliance of information with the CAQH (Council for Affordable Quality Healthcare) PECOS (Provider Enrollment Chain and Ownership System), NPPES and Cactus databases to ensure accurate and active clinician information. Supervises the enrollment process and compliance for Durable Medical Equipment. Collaborates, communicates and fosters relationships with the Payer and Medical Affairs, billing and VMG practice teams to ensure onboarding requirements for new clinicians are met and maintained. Assists the AVP of Clinician Contracting and Compliance in promoting VMG’s Goals and Objectives.

Position Responsibilities

Plans, supervises and oversees the daily operations of the VMG Credentialing Coordinators and Specialists to ensure compliance with CAQH regulatory requirements of the Cures Act, compliance with expirations of clinician licensures, collaborating agreements and CAQH attestations. Supervises the staff effectively to perform at optimal levels of quality standards and oversees the human resources and payroll of the staff.

Responsible for the collaboration of the VMG Credentialing team with the Payer and Medical Affairs and other VMG departments. Foster ways for the team to understand processes. Implements new procedures and ensures team meets current procedure requirements. Preserves the data integrity in the systems and spreadsheets utilized.

Responsible for managing, hiring and retention of office staff, including training, coaching and development. Provide orientation and training to new employees. Coordinates and monitors teams daily work and work flow and sets priorities. Escalation level for the team when clinicians are responding or difficult situations arise. Ensure that results are measured against standards, while making necessary changes along the way.

Participates in all project related functions in department, assists team members where required and maintains compliance with attestation for their own clinicians assigned. Responsible for planning, directing, strategizing and implementing projects with the team. Ensures payer audits of rosters are in compliance. Ensures departments policies are up to date streamlined and accurate.

Supports the educational and career development efforts of staff under purview. Acts as escalation point for management staff to address challenging operational and personnel issues. Acts as coach for development of the staff’s skill set.

Understands government regulatory directives and maintains compliance with regulatory guidelines for PECOS, CAQH, NCQA and DME.

Position Qualifications Required

Required Experience:

Minimum of 5 years of billing and credentialing. Minimum of 5 years of experience in a supervisory position. Excellent Communication skills (verbal-written-listening) in order to interact with employees at all levels and external clientele. Advanced organizational skills – ability to work pro-actively with changing priorities. Working knowledge of organization policies and procedures or ability to quickly learn and operate within those parameters.

Required Education

Associates degree required, Bachelors degree preferred.

Training / Certification / Licensure

NAMMS or Credentialing Specialist Certification preferred. Must be able to obtain within 6 months of hire.

Knowledge of Durable Medical Equipment compliance guidelines and enrollment.

Virtua Health

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