Director of Credentialing & Verification Office - Clinical Affairs

The University of Kansas Health System; United States; On-site; USD 120,000 - 180,000; Full time

Job summary

The University of Kansas Health System in Kansas City seeks a Director of Credentialing and Verification Office to lead enterprise-wide verification and credentialing efforts across Clinical Affairs.

This senior leadership role oversees the Medical Staff Office, implements standardized FPPE processes, and ensures compliance with Joint Commission and regulatory standards while managing staff.

Qualifications

• Bachelors degree in healthcare management, business administration, or related field.
• 0

Responsibilities

• Lead centralized verification and credentialing function across the enterprise.
• Oversee primary source verification and application management.
• Monitor sanctions and expirables as part of ongoing credentialing.
• Manage credentialing system/platform as enterprise process owner.
• Develop KPIs to assess credentialing effectiveness and compliance.
• Supervise Medical Staff Office managers and teams.
• Ensure licensures and certificates are up to date in credentialing files.
• Support Medical Staff Office meetings and related activities.
• Oversee payor audits and related processes.
• Perform professional, clinical, and technical competencies of the unit.

Skills

Leadership

Credentialing

Provider enrollment

Regulatory knowledge

Communication

Education

Bachelor's Degree in related field

Master's Degree

Tools

Microsoft Word

Microsoft Excel

Microsoft Outlook

PowerPoint

Visio

Microsoft Teams

Job description

Position Title

Director of Credentialing & Verification Office - Clinical Affairs Days - Full Time Wescoe Pavilion

Position Summary / Career Interest

Director of Credentialing and Verification Office is a system leadership position responsible for leading and managing enterprise-wide verification, credentialing, and oversight of medical staff office capabilities. The Director will be responsible to standardize the verification and credentialing processes across the organization as well as create a structure for consistent FPPE to occur at each site. The Director will have oversight of the Medical Staff Office Coordinators/Managers to ensure each medical staff is provided the level of support necessary.

Responsibilities and Essential Job Functions

Reports to the Associate Chief Medical Officer in the Clinical Affairs Department. Responsible for creation and continuous improvement of a centralized verification organization function, enabling all TUKHS to initiate a common application. Oversees and leads enterprise-level verification function for credentialing process including primary source verification, application management, initiating data gathering for provider enrollment, and performing ongoing monitoring of sanctions and expirables. Act as enterprise process leader for provider credentialing and business owner for credentialing system/platform. Responsible for continuous improvement in provider credentialing processes and overlapping processes such as provider enrollment and onboarding. Develops and monitors key performance indicators and metrics to assess provider credentialing effectiveness, efficiency and compliance. Leads one or more medical staff office managers and their teams. Oversees the initial credentialing and re-credentialing of all providers. Ensures that all licensures and other required certificates are up to date and filed in the provider’s credentialing file. Provides support for the Medical Staff Office capabilities including but not limited to, Medical Staff Executive Committees, Medical Staff meetings, and other appropriate meetings. Oversees delegated payor audits. Must be able to perform the professional, clinical and or technical competencies of the assigned unit or department.

Required Education and Experience

• Bachelors Degree in a related field (healthcare management, business administration, etc) from an accredited college or university.
• 5 or more years of experience in healthcare with specific experience in medical staff office affairs, credentialing, or provider services.
• Experience with delegated credentialing.
• Experience leading and managing direct reports, preferably in a production-related management role.
• Experience with provider enrollment process.

Preferred Education and Experience

• Master's Degree in related field from an accredited college or university.
• 2 or more years of medical staff office administrative management.

Required Licensure and Certification

• Certified Provider Credentialing Specialist (CPCS) - National Association of Medical Staff Services (NAMSS) or obtain certification within 12 months of hire.

Knowledge Requirements

Understanding of accreditation and regulatory standards related to medical staff functions (Joint Commission, CIHQ, NCQA, CMS, etc). Ability to establish and maintain effective working relationships with all levels of health system staff. Excellent interpersonal and communication skills. Must have strong presentation and leadership skills. Strong PC skills (Word, Excel, Outlook, PowerPoint, Visio, teams or equivalent).

Time Type: Full time

Job Requisition ID: R-58717

Equal Employment Opportunity & Diversity, Equity & Inclusion

The health system is an equal employment opportunity employer. Qualified applicants are considered for employment without regard to race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), national origin, ancestry, age, disability, veteran status, genetic information, or any other legally-protected status. See also Diversity, Equity & Inclusion. The health system provides reasonable accommodations to qualified individuals with disabilities. If you need to request reasonable accommodations for your disability as you navigate the recruitment process, please let our recruiters know by requesting an Accommodation Request form using this link [e-mail]. Employment with the health system is contingent upon, among other things, agreeing to the health-system-dispute-resolution-program.pdf and signing the agreement to the DRP.

About The University of Kansas Health System

As part of the region’s premier academic medical center, The University of Kansas Health System in Kansas City is a world-class healthcare provider and destination for complex care and diagnosis. We are driven by our commitment to service, continuous improvement and to the highest degree of excellence. Collaboration between physicians, nurses, researchers, educators and other professionals who share their expertise leads to exciting discoveries and life-changing treatments for the people we serve.