Regional Credentialing Responsibilities: Oversees and manages the VH Regional Credentialing Department, which is responsible for Insurance Credentialing and periodic insurance re-credentialing of providers, including facilities, clinics, specialty providers, and individual providers, maintenance of provider status in MSOW, CHMC credentialing and provider relations, Delegated Agreement management and coordination, as well as the Ambulatory Credentialing process. Trains staff and organizes daily workflow of all activities. Proactively monitors provider credentialing status and initiates re-credentialing processes in order to avoid credentialing lapses. Candidates in this position will have access to confidential employee, patient, organizational, and financial information that requires professional and appropriate discretion. This position requires an individual capable of acting independently and who employs sound organizational skills to coordinate the numerous activities related to provider enrollment and credentialing as well as maintaining follow- up correspondence related to those activities. Contracting and Managed Care Responsibilities: Supports the managed care and payer contracting responsibilities of the Director, Managed Care and Credentialing in a supplemental and advisory role. Maintains knowledge and awareness of payer contracting issues and status, keeps Director appraised of payer contracting issues affecting Provider Credentialing. Entity and Corporate Support Responsibilities: Works closely with and supports providers, executives, entity and departmental leadership, corporate teams (PFS, Strategic Fianance, Decision Support, reimbursement/tax, budgeting, and service line leaders) and other healthcare system teams to support growth opportunities and maintain integrity of ongoing system operations and services to meet the specific needs of network customers. Ensures timely and accurate credentialing of new providers and recredentialing/renewal of existing providers. Ensures the effective and timely delivery of quality reporting and services to VHS customers. Supports the Director, Managed Care and Credentialing in the development of payor agreements, annual operating and capital budgets, and assists in the seamless integration of these plans with the operating goals of system business units. Must maintain a positive attitude, goal-oriented attitude, promote the messaging of the organization, and maintain a professional and courteous demeanor with all interactions with all providers, coworkers, customers, superiors, and the general public.
Three years insurance credentialing experience required
Experience with centralizing the insurance credentialing process for six or more offices/facilities/ hospitals required Computer experience and knowledge of Microsoft Suite required Working knowledge of payer enrollment process for multiple states required Experience with physician relations required Knowledge of various databases used in payer credentialing, including CAQH’s Universal Provider Database and State Licensing Boards required Ability to manage multiple projects independently required
Committed to Making Our Communities Healthier
As a non-profit organization, Valley Health began its journey to bring better quality health to local communities in 1994. When Winchester Medical Center and Warren Memorial Hospital partnered to better serve their region, a vision was realized. That vision was to bring communities together with better quality health care and to meet their unique ne...eds by providing access to the latest advancements, technology, and developments in medical services.
With hospitals and medical facilities throughout West Virginia and the Top of Virginia region, Valley Health is a community partner. Based in Winchester, Virginia, Valley Health is composed of six core hospitals:
?Hampshire Memorial Hospital
?Page Memorial Hospital
?Shenandoah Memorial Hospital
?War Memorial Hospital
?Warren Memorial Hospital
?Winchester Medical Center
Valley Health brings together 604 licensed inpatient beds, 166 long-term care beds, 5,300 employees, and a medical staff exceeding 500 professionals.