Director of Credentialing - Dallas, TX

Integrative Emergency Services, LLC ("IES") is seeking a Director of Credentialing & Enrollment. This role provides strategic direction and oversees the development, implementation and maintenance of all enrollment and credentialing processes and projects. Responsible for develop ...

Job description

Integrative Emergency Services, LLC ("IES") is seeking a Director of Credentialing & Enrollment. 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. Will plan, budget, oversee and direct all aspects of payor enrollment and credentialing. Will critically review and analyze current practices and identify process improvements leading to best-practice operations. Will plan and manage credentialing and enrollment functional operations in alignment with the organization's values and in support of company goals and objectives. Role is based at Corporate office in North Dallas, 75244.

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.
 

ESSENTIAL DUTIES AND RESPONSIBILITIES The responsibilities listed here represent the majority of the role but are not all-inclusive; other duties may be assigned.

• Manage the administration of clinician credentialing and enrollment programs and procedures across all clients and service lines. Includes, but not limited to, Emergency, Hospitalist, Anesthesia, and Surgical.
• 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 the continuous enhancement of operations & 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 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 that clinicians and clients receive top-tier services throughout the credentialing and enrollment cycle.  Develop performance measurements to effectively maintain service level agreements and key performance indicators while adhering to budget. Develop and maintain dashboards for the business and/or clinical or management company leadership.
• Maintain broad and current subject matter knowledge and expertise regarding regulatory changes, trends, best practices, and technologies.  Use knowledge to provide advice and guidance to the organization surrounding solutions for credentialing or enrollment issues or needs and ensure organizational compliance to federal, state and/or client requirements.
• Manage all credentialing and enrollment projects, creating detailed plans and timelines to track progress.  Measure project performance using appropriate systems, tools, and techniques.  Manage to extremely high degree of accuracy with enrollment compliance to avoid timely filing or held A/R issues. Work closely with management, leadership and finance to analyze and resolve held A/R issues.  Facilitate meetings with billing company regarding enrollment status and current projects.
• Establish, maintain, and manage to a culture of customer service within the enrollment and credentialing departments to better serve clinicians and clients. Oversee processes and team to ensure regular communication with clients, third parties, vendors, clients and leadership.
• Collaborate with Medical Directors, Market Presidents, and other Clinical Executive Leaders to address client or practitioner credentialing and enrollment needs and/or 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

SUPERVISORY RESPONSIBILITIES
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.
 

QUALIFICATIONS

Knowledge, Skills, Abilities:  To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Strong understanding of credentialing standards such as NCQA/JCAHO requirements and payer regulations.
• Strong working knowledge of provider enrollment processes and payer requirements (Medicare, Medicaid, commercial payors).
• Previous experience working with CAQH and payer portals 
• Experience leading teams with multiple layers.
• Excellent interpersonal and communication skills, including the ability to interface with senior leadership and external partners.
• Strong analytical and problem-solving skills; ability to interpret data and implement performance improvements.
• Proficiency with Microsoft Office Suite (especially Excel), Credentialing systems (e.g., Salesforce), and experience with enrollment systems and tools.
• High attention to detail with the ability to manage competing priorities effectively.
• Knowledge of revenue cycle impact from enrollment delays or rejections.
• Strong customer service orientation and project management capabilities.
• Ability to use discretion appropriately and maintain confidentiality
• Ability to read, write and speak English proficiently

Education / Experience:  Include minimum education, technical training, and/or experience preferred to perform the job.

Required:

• High school diploma or GED
• 3-5 years' leadership experience
• 3 years' experience managing the provider enrollment and credentialing processes or related experience

Preferred:

• Bachelor's degree
• 5 years of healthcare management experience
• Previous experience working with CAQH, payer portals, & credentialing systems (Salesforce) 
• Familiarity with billing workflows and A/R management

PHYSICAL DEMANDS:  The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Specific vision requirements include the ability to see at close range, distance vision, peripheral vision, depth perception, and the ability to adjust focus
• While performing the duties of this job, the employee is regularly required to talk and hear
• Frequently required to stand, walk, sit, use hands to feel, and reach with hands and arms
• Possess the ability to fulfill any office activities normally expected in an office setting, to include, but not limited to:  remaining seated for periods of time to perform computer based work, participating in filing activity, lifting and carrying office supplies (paper reams, mail, etc.)
• Occasionally lift and/or move up to 20-25 pounds 
• Fine hand manipulation (keyboarding)

WORK ENVIRONMENT:  The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Office environment LBJ Fwy, Dallas, TX, 75244
  • Occasional Hybrid flexibility 
• May visit hospital locations and vendors 
• The noise level in the work environment is usually low

TRAVEL:

• Some travel, including overnight and local, may be required as business needs dictate.

ADA & Reasonable Accommodation Statement:
IES is committed to providing equal employment opportunities to qualified individuals with disabilities. In accordance with the Americans with Disabilities Act (ADA), reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of the job. If you require accommodation during the application or employment process, please contact [email protected].

The company is committed to creating a diverse, inclusive, and equitable environment and is proud to be an equal opportunity employer. Qualified applicants of any age, race, religion, nationality, sexual orientation, gender identity or expression, disability, or veteran status will receive equal consideration for positions. We welcome people of diverse backgrounds, experiences, and abilities and believe that the unique experiences of our team drive our success.