Medical Staff Credentialing Director jobs in Birmingham, AL

Pathway Healthcare is a leading behavioral health organization dedicated to providing comprehensive care for individuals facing mental health challenges, and substance abuse issues. We believe in a holistic approach to treatment, addressing both physical and mental well-being to foster lasting recovery and wellness.

We value our team members and want our team members to experience a positive culture where they feel valued. Our team members have access to health benefits, including Teladoc that is free to all full-time employees, as well as PTO, and paid holidays. If you are passionate about helping people and want to be part of a team where you will be valued and have the opportunity to grow, then send us your resume!

POSITION OVERVIEW

The Director of Credentialing will be responsible for overseeing all aspects of our credentialing process to ensure compliance with regulatory requirements and industry standards. This position requires strong leadership abilities, attention to detail, and a deep understanding of credentialing processes and best practices.

ROLE RESPONSIBILITIES

• Develop and implement policies and procedures for credentialing healthcare providers ensuring compliance with accreditation standards, state and federal regulations, and payer requirements.
• Manage the credentialing process from initial application through re-credentialing, including primary source verification, background checks, and review of licensure, certifications, education, and work history.
• Responsible for integration of newly acquired entities, including software and staff.
• Collaborate with internal departments, such as Human Resources, and Quality and Compliance to ensure alignment of credentialing processes with organizational goals and objectives.
• Maintain accurate and up-to-date credentialing files and databases, ensuring confidentiality and security of sensitive information.
• Serve as the primary point of contact for credentialing inquiries from healthcare providers, staff, and external stakeholders, providing timely and accurate responses.
• Monitor and evaluate the performance of credentialing staff, providing guidance, training, and support as needed to ensure high-quality and efficient credentialing processes.
• Stay informed about changes in credentialing requirements, regulations, and industry trends, and make recommendations for process improvements and enhancements.
• Prepare and submit reports on credentialing activities, compliance metrics, and performance indicators to senior management and regulatory agencies as required.
• Participate in audits, surveys, and accreditation reviews related to credentialing, providing documentation, and supporting evidence as needed.
• Represent the organization in meetings, conferences, and industry events related to credentialing and provider enrollment.

QUALIFICATIONS & EDUCATION REQUIREMENTS

• Bachelor’s degree in Healthcare Management, Business Administration, or other related field; Master’s degree preferred.
• Certification as a Certified Provider Credentialing Specialist (CPCS) or Certified Professional in Medical Services Management (CPMSM) preferred.
• Minimum of 7 years’ experience in healthcare credentialing, with at least 3 years in a leadership or supervisory role.
• In-depth knowledge of credentialing principles, processes, and standards, including NCQA, Joint Commission, and CMS requirements.
• Strong analytical skills with the ability to interpret complex regulations and accreditation standards.
• Excellent communication and interpersonal skills, with the ability to interact effectively with healthcare providers, staff, and external stakeholders.
• Demonstrated leadership abilities, including the ability to motivate and develop a team, foster a culture of accountability and continuous improvement, and achieve performance goals.
• Proficiency in credentialing software and database management systems.
• High level of integrity and discretion in handling confidential information.