This position under limited supervision, oversees the operations of the BHP Network Department to develop, manage and monitor processes and procedures that support the credentialing, re-credentialing, privileging, expirables, and network contracting processes. Oversees all of the credentialing functions including application management. Ensures compliance with the appropriate accrediting and regulatory agencies. Supervises network staff in the day-to- day management of the credentialing process and database management.
This position will be directly responsible for the development and implementation of contracting strategies including the negotiation of terms. Ensures compliance with contracting guidelines.
Supervision of Staff
Supervise the Network Department, including: hiring, orienting, coaching, evaluating and effectively managing performance to ensure staff possess the needed skills to deliver high quality service to customers
Provide ongoing, continuous management oversight as a coach who supports the growth and development of employees
Assess and direct or redirect daily workflow to ensure safety, accuracy and efficiency of work product
Recruit/interview/hire staff. Coordinate orientation of new staff, and ensure ongoing education of current staff
Provide training, mentoring, leadership and direction to staff.
Maintain and monitor the productivity level of staff to maximize efficiency and control costs. Manage the staffing schedule to assure adequate staffing levels, and approve timecards.
Create and support a productive team environment through effective communication and availability to team members. Model enthusiasm and dedication to work and tactical objectives
Supervision of Operations
Supervise the day-to-day operations of the Network Department to ensure exceptional care and services are provided to customers.
Act as an expert resource for staff to resolve issues and answer questions
Lead feedback and complaint resolution. Ensure all customer and staff concerns or complaints are handled promptly and properly. Document complaints, analyze for trends, and provide documentation to management.
Evaluate and recommend changes in processes and procedures.
Recommend policies and procedures to ensure efficient and profitable business operations. Implement and monitor as necessary, and maintain policy and procedures manuals.
Responsible for the operational goals of the department, including credentialing reports, staffing matrix, and regulatory reports and meeting National Center for Quality Accreditation (NCQA) guidelines.
Participate with leadership in the strategic planning process and establishment of operational goals. Ensure goals set for department are met.
Review administrative and clinical documentation daily, preparing a weekly report for management.
Administers the credentialing and privileging process for the BHP Licensed staff in accordance with Joint Commission Accreditation and CMS standards.
Responsible for leading the Credentialing Committee meetings.
Coordinates, oversees, and administers the credentialing, re-credentialing, and provider change processes for the BHP Network in accordance with NCQA requirements.
Ensures the accuracy of the BHP- Fairview specific medical staff bylaws, rules and regulations, and policies and procedures, ensuring compliance with accrediting organization requirements participates in development and review of the Network Operating policies and procedures, delegated credentialing policies and procedures, develops, recommends, and/or implements changes, revisions, and enhancements as appropriate to current operating environment.
Reviews, oversees, and advises behavioral staff leadership and administration regarding credentialing/ privileging of appointments, reappointments, and expansion/reductions requests: assess whether individuals with clinical privileges provide services within the scope of privileges.
Functions as primary credentials and privileging contact for all internal and external inquiries; serves as a primary point of liaison between senior management and behavioral staff, and develops and maintains positive working relationships.
Responsible for responding to queries pertaining to BHP service offerings, related to contracting into the network.
Provide expertise and answer questions for practitioners and office staff regarding BHPs network requirements and systems.
Responsible for the prospecting and contracting of behavioral providers in the target market.
Continuously inform and recruit clinics and providers to connect to the SchedulR and online systems.
Reviews all network contracts to make sure all providers are in our system either as organizational or credentialed.
Leads the entire network contracting process for all potential providers, including prospecting, negotiation, credentialing, and orientation.
Collecting all practitioner and ancillary signed contracts.
-Preferably in psychology or other human or social service field.
NAMSS Certification as a Certified Professional Medical Services Manager (CPMSM) or Certified Provider
Credentials Specialist (CPCS) or actively pursuing certification and ability to become certified within one year of hire.
-3 or more years of experience in a behavioral related field, managed care or call center.
1-3 years leadership experience in a behavioral related field, managed care or call center.
Together with the University of Minnesota and University of Minnesota Physicians we have created M Health Fairview. M Health Fairview is the newly expanded collaboration among the University of Minnesota, University of Minnesota Physicians, and Fairview Health Services. The healthcare system combines the best of academic and community medicine — expanding access to world-class, breakthrough care through our 10 hospitals and 60 clinics.
Fairview Health Services (fairview.org) is an award-winning, nonprofit health system providing exceptional care across the full spectrum of health care services. Fairview is one of the most comprehensive and geographically accessible systems in the state, with 10 hospitals—including an academic medical center and long-term care hospital—serving the greater Twin Cities metro area.
Its broad continuum also includes 60 primary care clinics, specialty clinics, senior living communities, retail and specialty pharmacies, pharmacy benefit management services, rehabilitation centers, counseling and home health care services, medical transportation, an integrated provider netwo...rk and health insurer PreferredOne. In partnership with the University of Minnesota, Fairview’s 32,000 employees and 2,400 affiliated providers embrace innovation to drive a healthier future through healing, discovery and education.