Director of Credentialing & Enrollment - Dallas, TX

Overview

Director of Credentialing & Enrollment at Integrative Emergency Services, LLC (IES). This role provides strategic direction and oversees the development, implementation and maintenance of all enrollment and credentialing processes and projects. Responsible for developing efficient and effective methods to ensure all providers are properly enrolled with all payors. Plans, budgets, oversees and directs all aspects of payor enrollment and credentialing. Reviews and analyzes current practices to identify process improvements for best-practice operations.

Plans and manages credentialing and enrollment functional operations in alignment with the organization’s values and company goals.

IES is dedicated to cultivating best practices in emergency care, providing comprehensive acute care services, creating value, and supporting patients, employees, clients, providers, and physicians in pursuit of the highest quality health care.

• Manage the administration of clinician credentialing and enrollment programs and procedures across all clients and service lines. Serve as the subject matter expert for group provider enrollment related matters. Oversee new group set-ups and ensure required documentation is submitted to the billing company.
• Design, implement, optimize, and manage Clinician Credentialing and Enrollment processes, workflows, and systems. Set the overall direction and drive continuous enhancement of operations and systems capabilities to reduce manual processes and create simple, compliant processes. Develop scalable methodologies and tools to optimize credentialing and enrollment operations and streamline core processes. Work with Recruiting and Operations leadership to identify, develop, recommend and implement best practices within the department and with inter-departmental processes.
• Develop internal operating procedures and controls. Incorporate policies, practices, and/or procedures into standard operating procedures (SOPs) to ensure efficient and effective services.
• Ensure clinicians and clients receive top-tier services throughout the credentialing and enrollment cycle. Develop performance measurements to maintain service level agreements and key performance indicators while adhering to budget. Develop and maintain dashboards for the business and for leadership.
• Maintain broad and current subject matter knowledge regarding regulatory changes, trends, best practices, and technologies. Use knowledge to provide advice and guidance on credentialing or enrollment solutions and ensure compliance with federal, state and/or client requirements.
• Manage credentialing and enrollment projects with detailed plans and timelines. Measure project performance using appropriate systems and tools. Maintain a high degree of accuracy with enrollment compliance to avoid timely filing or held A/R issues. Work with management, leadership and finance to analyze and resolve held A/R issues. Facilitate meetings with the billing company regarding enrollment status and current projects.
• Establish and maintain a culture of customer service within the enrollment and credentialing departments. Oversee processes and team to ensure regular communication with clients, third parties, vendors, and leadership.
• Collaborate with Medical Directors, Market Presidents, and other Clinical Executive Leaders to address client or practitioner credentialing and enrollment needs and concerns.
• Handle sensitive information in accordance with company protocols and ensure data security. Act as System Administrator for Operations Dashboard, managing team access and termination as appropriate.
• Handle sensitive information in accordance with company protocols and ensure data security.

This position carries out supervisory responsibilities in accordance with guidelines, policies and procedures and applicable laws. Supervisory responsibilities include interviewing, hiring, and training employees; planning, assigning and directing work; appraising performance; rewarding and disciplining employees; addressing complaints and resolving problems.

Knowledge, Skills,…