Manager - Medical Staff Services & Provider Enrollment

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This is a Stanford Health Care job.

A Brief Overview
The Manager provides operational oversight of the Credentialing and Privileging Services and/or Provider Enrollment for Stanford Health System and Affiliates. The scope of responsibility includes monitoring of all credentialing and privileging and/or enrollment processes and quality of work, problem resolution, and assurance of regulatory compliance, and assisting the Director with issues involving staff productivity, supervision, development, and evaluation. In addition, responsibilities include assisting the Director with Medical Staff Bylaws, form development, Rules and Regulations, Policies, and other administrative medical staff functions. Provides oversight and support to the government payor enrollment operations of current and new providers for the Stanford Health System and Affiliates. May participate in oversight of the compliance related to enrollment of providers, groups, and/or facilities with Medicare, MediCal, Medicaid, and California Children's Services (CCS). This position actively collaborates with the Director of Medical Staff Services, Chairpersons of the two Credentials Committees, the Chiefs of Staff, Clinical Service Chiefs, and the Medical Staff Committee Coordinator.

May need to present in person if business need identified.

Schedule M-F; Hours TBD (day shift)

Locations
Stanford Health Care

What you will do

• Manages and oversees the operational aspects of the credentialing function for Stanford Hospital and Clinics and Lucile Packard Children’s Hospital including Active Daily Management of all Coordinators to ensure timely completion of quality work.

• Assists the Director in selection, orientation, management, development, and evaluation of personnel assigned to the centralized credentialing office in accordance with standards of practice and policies and procedures. Ensures appropriate staffing levels to accomplish tasks assigned. Provides expertise and direction to staff for complex problem solving.

• Assists in maintaining compliance with NCQA, The Joint Commission, Title 22, and CMA credentialing standards. Collaborates with contracting health plans on provider panels, rosters, and credentialing issues.

• Assists the Director of Medical Staff Services in the design and development of efficient systems to promote departmental productivity, efficiency, quality service and compliance with regulatory standards. Responsible for departmental fiscal and budgetary activities as well as special projects. Responsible for oversight of Credentialing revenue and expenses.

• Functions as a liaison to both internal and external customers, including SHC and LPCH administrative departments, physicians, service lines, regulatory agencies, medical groups, hospitals, and health plans. Serves as a resource to credentialing staff, administration, medical staff leadership and medical staff.

• Implements and oversees information systems solutions to maintain accurate and adequate data on Medical Staff and Advance Practice Professionals.

• Works with the Credentials Committee Chairpersons to deal with questions regarding the credentialing process and to ensure consistency on credentialing issues at all sites.

• Serve as a resource to the Medical Executive Committees, Credentials Committees, Clinical Departments, and SHC and LPCH Administration on Medical Staff issues.

• Maintain knowledge of payor enrollment requirements and provide oversight and direction to the Provider Enrollment Coordinators.

• Understand enrollment functions that support appropriate payor contracting and claims adjudication.

• May assist with ensuring that all professional revenue can be billed and paid by payors.

• Serve as a contact/resource to other departments and clinics for information on payor guidelines; updates staff and outside departments on government (Medi-Cal/Medicaid/Medicare/CCS) regulations.

• Establish workflows are operating optimally to meet organizational goals and ensure timely reimbursement and participate in corrective measures as necessary.

• Collaborate with hospital departments regarding status of patient accounts relating to government payor enrollment to identify and resolve billing and processing problems in a timely manner.

• May participation in meetings with payor representatives including Professional Billing Office Representatives (i.e., Revenue Cycle Leadership) to resolve any payment or policy issues.

• Oversee and collaborate with management concerning revenue cycle projects regarding denials, write offs, or process improvements.

• Evaluate and participate in resolving any Epic issues that impact the billing and follow up workflow processes.

Education Qualifications

• Bachelor's degree in a work-related discipline/field from an accredited college or university

Experience Qualifications

• Minimum of five (5) years’ experience in a healthcare environment and three (3) years of credentialing management experience required, or
  
  A combination of education and experience as defined above will be considered

Required Knowledge, Skills and Abilities

• Excellent organizational, management, and communication skills, both oral and written, are essential.

• Ability to function independently with excellent judgment, logical reasoning and critical thinking skills and minimal supervision.

• Ability to interpret and analyze Medical Staff Bylaws, Rules and Regulations and Policies.

• Discretion, confidentiality, tact, and the ability to deal with sensitive issues is required.

• Advanced computer skills.

Licenses and Certifications

• CPMSM - Cert Prof Med Services Management or

• CPCS - Certified Provider Credentialing Specialist

These principles apply to ALL employees:

SHC Commitment to Providing an Exceptional Patient & Family Experience

Stanford Health Care sets a high standard for delivering value and an exceptional experience for our patients and families. Candidates for employment and existing employees must adopt and execute C-I-CARE standards for all of patients, families and towards each other. C-I-CARE is the foundation of Stanford’s patient-experience and represents a framework for patient-centered interactions. Simply put, we do what it takes to enable and empower patients and families to focus on health, healing and recovery.

You will do this by executing against our three experience pillars, from the patient and family’s perspective:

• Know Me: Anticipate my needs and status to deliver effective care

• Show Me the Way: Guide and prompt my actions to arrive at better outcomes and better health

• Coordinate for Me: Own the complexity of my care through coordination

Equal Opportunity Employer Stanford Health Care (SHC) strongly values diversity and is committed to equal opportunity and non-discrimination in all of its policies and practices, including the area of employment. Accordingly, SHC does not discriminate against any person on the basis of race, color, sex, sexual orientation or gender identity and/or expression, religion, age, national or ethnic origin, political beliefs, marital status, medical condition, genetic information, veteran status, or disability, or the perception of any of the above. People of all genders, members of all racial and ethnic groups, people with disabilities, and veterans are encouraged to apply. Qualified applicants with criminal convictions will be considered after an individualized assessment of the conviction and the job requirements.

The salary of the finalist selected for this role will be set based on a variety of factors, including but not limited to, internal equity, experience, education, specialty and training. This pay scale is not a promise of a particular wage.