Baldwin Health

Job Summary

The Director, Credentialing is responsible for leading and overseeing the credentialing and re-credentialing processes for healthcare providers within the organization. This role ensures compliance with regulatory standards, manages credentialing operations, and maintains accurate and up-to-date records of provider credentials. The Director collaborates with leadership, medical staff, and external agencies to streamline processes, uphold quality standards, and support the organization's commitment to patient safety and care quality.

Essential Functions

• Develops, implements, and monitors policies and procedures for credentialing and re-credentialing to ensure compliance with regulatory and accreditation standards.
• Oversees all credentialing operations, including application processing, verification, and review, ensuring timely and accurate credentialing of providers.
• Ensures the maintenance of accurate and comprehensive credentialing records, coordinating with medical staff and relevant departments.
• Analyzes and improves credentialing processes to enhance efficiency, accuracy, and compliance.
• Manages relationships with external credentialing bodies, regulatory agencies, and accrediting organizations to facilitate compliance and alignment with industry standards.
• Leads and mentors the credentialing team, providing support in professional development, performance evaluations, and training.
• Collaborates with other departments to address credentialing issues and enhance service delivery.
• Prepares and presents reports to senior leadership on credentialing metrics, status updates, and quality improvement initiatives.
• Performs other duties as assigned.
• Complies with all policies and standards.

Leadership Responsibilities

• Supervision and Staff Management
  • Provides leadership, mentorship and professional development opportunities for departmental staff.
  • Schedules employees to ensure effective use of resources. Consults with leadership on any potential staffing issues.
  • Conducts performance evaluations, sets goals and provides feedback to staff on their performance and development.
• Strategic Planning and Financial Oversight
  • Collaborates with hospital leadership to set the strategic direction for the department, including budgeting, resource allocation and long-term planning.
  • Monitors expenditures, ensuring cost-effective delivery of services.
  • Evaluates and implements new technologies to enhance operational efficiency.
  • Develops and implements departmental policies and procedures and protocols to optimize quality and overall efficiencies.
• Quality Assurance and Regulatory Compliance
  • Ensures compliance with all relevant regulatory bodies. May oversee the accreditation process with relevant agencies ensuring that services meet or exceed industry standards.
  • Participates in audits, inspections and accreditation processes as applicable.
  • Follows established quality control practices to ensure accuracy, consistency and safety.
• Collaboration and Communication
  • Works closely with leadership teams to coordinate and improve service delivery.
  • Stays up-to-date with industry advancements, new technologies, and regulatory changes.
• Staff Responsibilities
  • May work in a staff role, when required. Ensures that duties and responsibilities are fulfilled while meeting all competencies established for that job.

Qualifications

• Bachelor's Degree in Healthcare Administration, Business, or a related field required
• 5-7 years of experience in credentialing, with three (3) years in a leadership role required

Knowledge, Skills and Abilities

• In-depth knowledge of credentialing processes, regulatory standards, and industry best practices.
• Strong leadership skills to guide and develop the credentialing team effectively.
• Excellent analytical skills for quality improvement and process optimization.
• Effective communication and collaboration skills to work with internal teams and external agencies.
• Organizational skills to manage complex records, documentation, and compliance requirements.

Licenses and Certifications

• Certified Provider Credentialing Specialist (CPCS) preferred
• Certified Medical Professional Services Management (CPMSM) preferred