Director of Provider Credentialing

The CHRISTUS Health / CHRISTUS Connected Care Network System Director -- Network Development has overall operational responsibility for the provider contracting and provider relations processes for all CHRISTUS Health Population Health (CHPH) entities including CHRISTUS Connected Care Network (CCCN), CHRISTUS Health Plan (CHP), Accountable Care Organizations, and other risk bearing entities. In this role, this individual is accountable for the recruitment, contracting and retention of network providers. Additionally, this individual has operational responsibility for the CHRISTUS Health systemwide credentialing process including the application process and credentials verification office. He / she will oversee the accreditation of the credentialing office and the delegation of managed care credentialing for all network providers. This individual serves as a member of the CCCN executive team. This position may have expanded responsibilities in population health / CHRISTUS Connected Care Network as the need arises.

MAJOR RESPONSIBILITIES

Provider Credentialing

Summary:

Responsible for the development and management of a comprehensive provider credentialing office for all CHRISTUS Health entities. Obtains accreditation of the credentialing office and obtains delegation for the managed care credentialing of CHPH network providers.

• Assists senior leaders in the development of provider credentialing policies for all CHRISTUS Health entities.
• Develops and executes all credentialing procedures and processes.
• Develops and maintains a collaborative relationship with all CHRISTUS Health entities. Negotiates credentialing service standards with all entities. Meets or exceeds all credentialing service standards.
• Establishes and executes a comprehensive credentialing verification office for all CHRISTUS Health entities.
• Negotiates and develops credentialing office budgets with CHRISTUS Health entities and carries out billing and collection processes.
• Develops standards for a single, system-wide credentialing software application and ensures those standards are fully met in a manner that is consistent with all accreditation, regulatory and legal standards.
• Obtains and maintains appropriate accreditations for the CCCN credentialing office.
• Obtains delegation for managed care credentialing for all network providers.
• Evaluates opportunities for external revenue generation by selling credentialing services to other entities.

General Duties

• Ensure compliance with all government, payer, or accreditation laws, rules, regulations and policies and all medical staff bylaws and policies.
• Ensure compliance with all CHRISTUS Health policies and standards.
• Develop and manage departmental budgets.
• Supervise all departmental staff including the effective hiring, training and managing of staff.
• Prepare and analyze reports and present information to leaders.

A. Education/Skills

• Bachelor's Degree required, Master's Degree preferred.
• Excellent negotiation skills
• Computer skills including significant knowledge of Word, Excel, and Powerpoint

B. Experience

• 10 years of experience in managed care contracting and provider relations.
• Extensive knowledge and experience in hospital medical staff and managed care credentialing, including delegated credentialing.
• 5 years of experience in management / direct supervision of staff.

C. Licenses, Registrations, or Certifications

• N/A