Director of Credentialing – Lewisville, TX – RELOCATION OFFERED!

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The Director of Credentialing is responsible for all credentialing of BayMark Health Services entities. They will lead and direct all credentialing activities related to government, commercial insurance, state licensing, and business related contract forms. Additionally, the Director of Credentialing will review, design, and implement processes surrounding provider profiles, credentialing with various payers, contract maintenance, application preparation, credentialing reappointment, provider databases, and facility databases.

Essential Job Functions:

• Oversees and/or performs all aspects of the licensing, credentialing, and government contracting.
• Streamline and scale credentialing and contracting process through technology to improve output.
• Conduct routine process improvement events, effectively communicate changes, and improvements to operations and senior leadership.
• Maintains productive outcomes for the department and manage staff to meet deadlines for business and credentialing commitm
• Work with outside resources such as NCQA credentials accreditation to streamline provider data.
• Work with payers to establish delegated credentialing.
• Hires, evaluates, and develops staff to reach goals and ensure team-centric environm
• Coordinates the communications between HR, TCDs (Treatment Center Directors), providers and the NSC Credentialing Department to insure effective and efficient credentialing processes.
• Collects and analyzes information, prepares files for approval process and ensures that credentialing files are kept accurate, complete and cur
• Maintains and updates Provider and Facility databases to include licensure, education, and training.
• Forecasts upcoming reappointments and ensures that applications have been received, documenting when applications are sent out as well as updating database with new reappointment date
• Generates monthly/quarterly/annual reports for providers and/or facility staff
• Provides excellent customer service and maintains communication with individuals throughout the organization.
• Maintains a regular and present in office schedule adhering to company policies at all tim
• Ability to maintain a positive attitude and provide customer support to clin
• Consults management and initiates changes in procedure with approv Acts as a resource and subject matter expert in the development of credentialing protocols.
• Ensures compliance with all internal controls, policies and procedures
• Perform and complete special projects as assign

Minimum Qualifications:

• A bachelor’s degree in a relevant field.
• Five (5) or more years of previous credentialing experience either in a physician’s office or hospital setting.
• Eight (8) or more years of management experience in increasingly responsible roles.
• Experience talking to government payers, especially Medicaid and Medicare application processing.
• Governmental contract experience and comprehension.
• New technology implementation experience.
• Strong demonstrable knowledge of third party credentialing with an emphasis on government and commercial payers. Ability to advocate successfully on our behalf for behavioral health with new payers.
• Previous exposure and understanding of medical terminology as it relates to BayMark’s business.
• Experience with NCQA credentialing database and delegated credentialing.
• Technology experience with platforms such as Symplr, Cactus, and similar contract management tools.
• Strong working knowledge of different MCO credentialing requirements
• Knowledge of CAQH Pro-View and CAQH Enroll-Hub
• Work with team of 20+ people while demonstrating good leadership and supervisory skills, driving the team to achieve goals and objectives.
• Exhibits excellent written, documentation and oral communication skills.
• Compliance with accepted professional standards and practices.
• Demonstrates discretion in handling confidential and sensitive information.
• Initiative to take charge of unforeseen situations, solve problems and adjust to schedule changes.
• Build teams of diverse backgrounds and abilities.
• Demonstrate ability to work independently and collaboratively with ability to adapt to shifting priorities, demands and timelines.
• Accuracy and attention to detail and follow-through.
• Proficiency with computer systems, working knowledge of Microsoft Office including proficiency in Excel, Internet and various software applications.
• Customer service focused, eager and energetic and ability to work with a diverse population
• Exhibits good time management skills.
• Ability to work in an interdisciplinary setting.
• Satisfactory criminal background check.
• Satisfactory drug screen.

Benefits:

• Competitive salary
• Comprehensive benefits package, including medical, dental, vision and 401(K)
• Generous paid time off
• Excellent growth and development opportunities
• Satisfying and rewarding work striving to overcome the opioid epidemic

Here is what you can expect from us:

BayMark Health Services a progressive substance abuse treatment organization is committed to the highest quality of patient care in a comfortable outpatient and inpatient clinic setting. Our ultimate goal is to address the physical, emotional, and mental aspects of opioid use disorder to help each of our patients achieve long-term recovery and an improved quality of life.

BayMark Health Services is committed to Equal Employment Opportunity (EEO) and to compliance with all Federal, State and local laws that prohibit employment discrimination on the basis of race, color, age, natural origin, ethnicity, religion, gender, pregnancy, marital status, sexual orientation, citizenship, genetic disposition, disability or veteran’s status or any other classification protected by State/Federal laws.