Supervisor Credential Verification

MINIMUM QUALIFICATIONS:

EDUCATION, CERTIFICATION, AND/OR LICENSURE:

1. High School Diploma or GED

2. Certification by National Association of Medical Staff Services (NAMSS) as a Certified Provider Credentialing Specialist (CPCS) required within two (2) years of hire

EXPERIENCE:

1. Five (5)years experienceas a Medical Staff Coordinator or equivalent

PREFERRED QUALIFICATIONS:

EDUCATION, CERTIFICATION, AND/OR LICENSURE:

1. Bachelor's degree

CORE DUTIES AND RESPONSIBILITIES:The statements described here are intended to describe the general nature of work being performed by people assigned to this position. They are not intended to be constructed as an all-inclusive list of all responsibilities and duties. Other duties may be assigned.

1. Attends to a variety of administrative details such as departmental activities, transmission of information, adherence to policies and procedures and monitoring the day-to-day operations of the CVO.

2. Supervises the workflows and operations of the CVO staff in completing,submittingand tracking of provider applications for WVUHS or WVUH companies' facilities, while ensuring timely follow-up.

3. Serves the functions of the CVO Director as necessary in his/her absence.

4. Ensure complete and timely data collection and submission of credentialing/recredentialing requests to meet all CMS, JC and NCQA requirements

5. Assists the Director with conflict resolution when there are issues arising between a provider and the CVO or a WVUHS facility and CVO.

6. Demonstrates expertise in understanding of NCQA, JC, and CMS standards as it relates to the credentialing process.

7. Assists in the development of processes and workflows to ensure timely completion of provider credentialing.

8. Advises the Director of any problems or perceived problems with credentialing/recredentialing applications, or breakdowns in the application process flows.

9. Evaluate and redistribute work among staff members when necessary to ensure maximum productivity.

10. Develops and maintains credentialing benchmarks (turnaround times, volumes, etc.) and identifies opportunities for quality improvement.

11. Oversees the creation and preparation of reports including weekly WVUHS or WVUH companies' facility reports.

12. Assists the Director in developing and monitoring short-term goal setting and long-range plans for the department.

13. Serves as a liaison between the CVO and West Virginia United Insurance Services (WVUIS).

14. Collaborates with IT and the credentialing software vendor to maintain a current system through updates and training.

15. Collaborates with IT and the credentialing software vendor to resolve issues and/or enhance software capabilities.

16. Undertakes special projects as assignedin order tofacilitate departmental initiatives.

17. Consistently ensures a customer service orientationwith regard torequests, customer problems, complaints, suggestions, etc. and follows through with and/or resolves while presenting an image of professionalism.

18. Contributes to the goals of the organization and reflects the values of WVUHS by actively promoting and helping to maintain interactions with others inside and outside of the organization in a positive, professional, team-orientedand service-conscious manner.

19. Works effectively,confidentlyand pro-actively with others throughout the WVUHS.

20. Nurtures an atmosphere of collaboration and team oriented interpersonal relationships, communication flow and information sharing between WVUHS facilities.

21. Demonstrates a respect for the human dignity of all individuals (employees, physicians, peers, volunteers, customers, visitors, etc.); helps to create and maintain teamwork within the work environment; practices good negotiation skills for resolving conflicts under time pressures and deadline commitments.

22. Maintains proper attendance and punctuality to ensure continuity in the functions of the position.

23. Maintains a high level of confidentiality in all aspects of the position

PHYSICAL REQUIREMENTS:The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

WORKING ENVIRONMENT:The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1. Standard office environment.

SKILLS AND ABILITIES:

1. Ability to work extended hours as needed.

2. Analytical and problem-solving skills with excellent attention to detail.

3. Ability to function in a demanding and fast-paced environment.

4. Possess excellent organizational and prioritization skills andhave the ability towork on several projects simultaneously.

5. Ability to carry out a range of functions: organize, delegate, direct, and review the work of others; maintain an effective work pace under deadlines; learn and apply pertinent statutory provisions, rules, regulations, policies, procedures; read and understand manuals and other detailed books of instruction; create action plans for special projects; and manage the implementation process through completion.

6. Proficient computer skills, thorough knowledge and understanding of office software programs including, but not limited to: Windows, MS Office, Excel,Outlookand the ability to create, update and run reports in the electronic credentialing software or similar applications.

7. Knowledge of Joint Commission, NCQA, and CMS standards.

8. Possess excellent communication skills.

Additional Job Description:

Scheduled Weekly Hours:

Shift:

Exempt/Non-Exempt:

Company:

Cost Center:

Address:

Equal Opportunity Employer

West Virginia University Health System and its subsidiaries (collectively "WVUHS") is an equal opportunity employer and complies with all applicable federal, state, and local fair employment practices laws. WVUHS strictly prohibits and does not tolerate discrimination against employees, applicants, or any other covered persons because of race, color, religion, creed, national origin or ancestry, ethnicity, sex (including gender, pregnancy, sexual orientation, and gender identity), age, physical or mental disability, citizenship, past, current, or prospective service in the uniformed services, genetic information, or any other characteristic protected under applicable federal, state, or local law. All WVUHS employees, other workers, and representatives are prohibited from engaging in unlawful discrimination. This policy applies to all terms and conditions of employment, including, but not limited to, hiring, training, promotion, discipline, compensation, benefits, and termination of employment.