Director, Credentialing Operations

IntelliSoft Group – IntelliCVO

IntelliCVO is a Wholly owned subsidiary of IntelliSoft Group.  It is certified by the National Committee of Quality Assurance (NCQA).  It is positioned for both organic and inorganic growth along with the growth that will come with the effective launch of the IntelliSolution product line that was introduced in the 4th quarter of 2016.

Key Responsibilities

Manage a team of credentialing specialists who provide services such as primary source verification, third-party payer enrollment, appointment cycle tracking, and expiring credential tracking.

Oversee the daily workload of the staff in order to ensure that IntelliCVO policies and procedures are followed and that tasks are completed in accordance with the NCQA credentialing standards and other requirements of each client.  Monitor the volume of work being done by CVO staff and assist where needed, identify where shifts in workload and/or priorities may be needed in order to maintain efficiency.

Must have a thorough and recent working knowledge of important industry standards set forth by organizations such as the Joint Commission, the National Committee for Quality Assurance, CMS, etc.

Ability to provide training and coaching to the CVO staff as it relates to current industry standards, CVO policies and procedures.  Provide continuous feedback to Executive Staff as it relates to observed issues with CVO staff, volume of work, customer concerns, metrics and issues, etc. This position is located in our Nashua, NH office.

The selected individual will be able to perform the following tasks and as such will be responsible for assuring the following activities are completed efficiently.

  • Insuring that each credentialing file is complete and contains all documents and other important information needed for credentialing
  • Accurate and timely completion of data entry so that credentialing can proceed without delay
  • Credentials verification of physicians, allied health and other health care providers for whom the client is obligated by policy or industry standard to perform primary source verification
  • Ongoing communication with practitioners being credentialed so that any missing information is obtained in a timely manner
  • Ongoing follow up with 3rd party organizations providing the information needed for verifications
  • Timely completion of credentials files in order to meet important deadlines and target dates belonging to each client and revenue goals of the CVO
  • Accurately identify the materials needed by the client whose providers will enroll in one or more third-party health plans
  • Obtain the materials needed for health plan enrollment in a timely manner to avoid delays in that process that could slow the ability of the client to bill for provider services
  • Ongoing communication with provider and the client to ensure all information is needed for credentialing applications
  • Ongoing follow up with health plans to ensure continuous tracking of the status of the providers’ enrollments with any number of health plans
  • Timely creation of credentialing status reports that are sent to CVO clients
  • Other tasks as may be needed from time to time as requested by the client or requested by IntelliSoft Group Senior Management.

Educational Requirements

Qualifications:

  • Manager or Supervisor of Credentialing/Provider Enrollment team
  • 10+ years’ experience with healthcare credentialing or working in healthcare environment
  • Experience with policy and procedure development and implementation
  • Experience developing and tracking key performance and quality metrics
  • Experience with commercial credentialing software
  • BA/BS degree
  • Excellent written and verbal communications skills and organizational ability
  • Ability to multi-task and prioritize on the fly

Please email your resume to Mitch Martin at mmartin@nullintellisoftgroup.com