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Credentialing Director

Job Category:

BPO / KPO / Shared Services

Job Level:

Executive

Open Date:

30-Aug-2019

Location:

TAGUIG CITY

Close date:

29-Sep-2019

Client Industry:

BPO

Job Description and Qualification:

The Credentialing Director is supporting company’s strategic goals and improving Company’s business performance, with overall responsibility for credentialing operations for US business units and providing legal counsel for the company’s Global Business Center (GBC) in Taguig, Philippines in partnership with the Head of the GBC and US leadership. The position will have the responsibility to ensure that the GBC provides all US business units with effective and efficient transactions processing, understand customer needs, strive for customer satisfaction, as well as, managing compliance, managing contracts, managing legal operations, and supporting corporate activities. 


Responsibilities and Duties

Legal Counsel:

  • Create a GBC-wide strategy for the legal function. Create and implement strategies for managing GBC legal risk. Supervise and enhance the strategies, plans, and policies supporting the legal function.
  • Define and oversee all legal activities and determine authority/responsibility of legal department and line management within those processes. Activities include:
    • Review and evaluate legal documents such as contracts, license, and real estate and examine any documents for legal implications. Negotiate and document agreements and contracts to ensure the company’s full legal rights
    • in relation to a particular situation
    • Resolve disputes and litigations internally or externally. Manage dispute investigation, counsel stakeholders, administer litigation/arbitration case management, ensure legal administration and support, manage external counsel, and conduct incident management
    • Support the efforts and activities for remediation to resolve any legal concern. Create plans for corrective action in collaboration with the organization's operations and relevant external parties
    • Perform regulatory reporting and support ah-hoc corporate activities as required such as corporate finance, development, and M&A
    • Specify internal governance policies and regularly monitor compliance
  • Develop and drive organizational effectiveness and support the GBC on all major initiatives
  • Manage, lead, and direct the entire legal department including creating and administering budget for the entire legal function

Credentialing:

  • Create a GBC-wide strategy for the credentialing function. Lead credentialing activities focusing on establishing the qualifications of licensed medical professionals and assessing their background and legitimacy. Supervise and enhance the strategies, plans, and policies supporting the credentialing activities
  • Responsible for operational oversight of the Global CVO (GCVO).
  • Works directly with health plan oversight personnel to ensure compliance with mandated regulations and guidelines, facilitates and performs all health care audits as scheduled and ensures that all health plan reporting is completed and submitted within the mandated timeline
  • Attends internal and external meetings
  • Ensures that performance improvement initiatives are being identified and implemented.
  • Attends leadership meetings as needed
  • Participates in, develops, and implements any health care audits, accreditation surveys, and all corrective action plans related to the credentialing process
  • Oversee non-exempt staff
  • Collaboration with other departments (e.g., Legal, Compliance, etc.)
  • Plan, direct, supervise, and coordinate work activities of subordinates
  • Monitor and report on performance and take corrective actions as required
  • Ensure that activities performed meet quality standards
  • Responsible for budgeting staff and finances for credentialing function
  • Hire, train, evaluate, and supervise staff
  • Establish and maintain relationships within the GBC and US business units and provide assistance with problems stakeholders may encounter
  • processing per agreed service level agreements
  • Develop and drive organizational effectiveness and support the GBC on all major initiatives

Functional Area Outcomes and Expectations

  • Ensure strategic goals and projects are implemented efficiently to meet Company’s strategic goals and objectives
  • Establish and foster a strategic vision to ensure the GBC is viewed as a valued partner and appropriately involved in business decisions
  • Create positive relationship among key stakeholders
  • Ensure that the GBC is in compliance with Company-specific and healthcare regulatory requirements
  • Manage the credentialing function cost effectively and efficiently
  • Deliver credentialing services and solutions within budget approved and service commitment
  • Ensures the department complies with all required credentialing standards, including, but not limited to, primary source verification of documents, processing of applications and NPDB queries.

Knowledge, Skills and Abilities

  • Experience managing teams in a shared service center environment, with proven experience in training, coaching, and developing key resources
  • Demonstrated ability to manage stakeholder relationships across diverse geographies/locations and business units within a hospital organization
  • Maintains a through and working knowledge of important industry standards set forth by organizations such as the Join Commission, NCQA, CMS, etc.

·         Willingness to travel

·         Strong knowledge of the credentialing process and procedures, and other applicable regulations and requirements

·         Demonstrates leadership, critical thinking and time management skills

·         Strong attention to detail

·         Experience overseeing departments 

·         Strong problem-solving and analytical skills

·         Strong written and verbal communication skills



Salary:

PHP 1M – 1.9M