How will this role have an impact?

The Director of Credentialing oversees the Credentialing Department and works closely with the Network Management, Operations, CDI and Clinical Operations Departments in order to ensure that Signify Health clinicians adhere to the company’s policies pertaining to documentation, credentialing and clinical interaction with members. The Director of Credentialing coordinates and participates in quality improvement activities to ensure compliance and continuous improvement of Signify Health policies and procedures related to contracted physician clinician interaction, credentialing and quality assurance. This role will oversee the preparation of materials submitted to the Credentialing Committee for review of clinicians. This role is also responsible for training and mentoring team members, as well as, reducing/maintaining credentialing file cycles time from initial (recredentialing) review to committee approval. Additionally, the Director of Credentialing will educate and effectively work the credentialing team and clinicians to facilitate a seamless credentialing experience.

This position reports to the Senior Director, Network Operations.

Essential Job Responsibilities:

• Ensure that the organization and staff are in accordance with organizational, client and industry standards and regulations (CMS, NCQA, URAC, etc.)
• Oversee staff operations, business planning and budget development
• Provide reports to all internal and external stakeholders when requested
• Oversee and help manage the end to end credentialing process.
• Maintain accuracy of MD Staff
• Assist/coach/coordinate with Credentialing Manager(s) on a consistent basis, as well as other departments.
• Perform other related duties as required

Qualifications:

Education/Licensing Requirements:

• Bachelor’s Degree
• CPCS, CPMSM or equivalent experience preferred
  
  

Experience Requirements:

• Minimum 10 years of experience in healthcare related to Credentialing
• Prior experience with Managed Care is preferred
• Minimum of 5 years of management experience
• Prior experience in managing a Credentialing Department
• Knowledge of the Credentialing standards for the National Committee for Quality Assurance (NCQA) and relations for the Centers for Medicare and Medicaid Services (CMS)
• Knowledge of the Utilization Review Accreditation Commission (URAC) is preferred

Positions Reporting to this Position:

• Credentialing Managers
• Provider Enrollment Manager

Essential Skills/Experience:

• Fluently speak, read, and write English
• Excellent verbal and written communication skills
• Advanced knowledge of Microsoft Office (specifically Microsoft Excel) and the Google-Suite platform
• Knowledge in Medical Staff Bylaws
• Knowledge of federal, state and CMS credentialing standards
• Knowledge of state licensing requirements
• Experience in medical records management
• Familiarity with medical terminology
• Excellent verbal and written communication skills
• Proven ability to prioritize and multi-task
• Accurate data entry skills
• A leader with excellent teamwork skills

Essential Characteristics:

• Self-directed, organized, and manage time effectively
• Ability to maintain confidentiality
• Team player
• Detail-oriented, catches error early
• Sense of urgency
• Customer service orientation
• Ability to work under pressure
• Ability to work well independently
• Ability to manage large teams

About Us:
Signify Health is helping build the healthcare system we all want to experience by transforming the home into the healthcare hub. We coordinate care holistically across individuals’ clinical, social, and behavioral needs so they can enjoy more healthy days at home. By building strong connections to primary care providers and community resources, we’re able to close critical care and social gaps, as well as manage risk for individuals who need help the most. This leads to better outcomes and a better experience for everyone involved.
Our high-performance networks are powered by more than 9,000 mobile doctors and nurses covering every county in the U.S., 3,500 healthcare providers and facilities in value-based arrangements, and hundreds of community-based organizations. Signify’s intelligent technology and decision-support services enable these resources to radically simplify care coordination for more than 1.5 million individuals each year while helping payers and providers more effectively implement value-based care programs.
To learn more about how we’re driving outcomes and making healthcare work better, please visit us at www.signifyhealth.com.

Diversity and Inclusion are core values at Signify Health, and fostering a workplace culture reflective of that is critical to our continued success as an organization.
We are committed to equal employment opportunities for employees and job applicants in compliance with applicable law and to an environment where employees are valued for their differences.