This job exists to implement the credentialing plan of The Methodist Hospital Physician Organization and to ensure compliance with all organizational policies and procedures and fulfill credentialing requirements for participation in selected managed care organizations. PATIENT AGE GROUP SERVEDThere is no direct patient care for this role.DUTIES AND RESPONSIBILITIES1. Develops, communicates, and maintains standard operating procedures for the department to ensure timely credentialing of all member physicians and allied health professionals. 2. Facilitates the credentialing function for physicians and allied health professionals. Critical activities include oversight of the completion of the Texas Standard Credentialing Application and the CAQH online credentialing application as well as enrollment in the Federal and State Medicare and Medicaid programs. Additional functions include facilitation of hospital privileging with all Methodist Health Care System hospitals, expiration management of all licenses, certifications, insurance, etc., and delineation of responsibilities for all allied health professionals .3. Develops and maintains oversight of all credentialing policies and procedures through the establishment of a credentialing committee comprised of member physicians of the organization. Provides ongoing staff support to this committee.4. If credentialing functions are delegated to a third party, maintains policies and procedures for delegated credentialing services and provides management and oversight to the Credentialing Verification Organization (CVO) and conducts onsite audits on a periodic basis and documents findings. Through the audit process, ensure findings are compliant with requirements of third party managed care organizations that look to the CVO for TMHPO credentialing information.5. Regularly communicates with providers, TMHPO Department Administrators, and other TMHPO departments regarding credentialing status and information.6. Oversees the ongoing maintenance of a complete organizational listing of all providers, credentialing dates, and managed care plan participation.7. Has a working knowledge of NCQA and JCAHO physician credentialing requirements.8. Sets performance criteria for credentialing staff, communicates expectations and outcomes, and evaluates individual and team performance. Manages staff by providing coaching and guidance in specific areas related to overall job performance and accountability.9. Provides relevant information to department director for effective budget planning. Monitors department expenditures and manages resources to support the approved budget.10. Attends to other duties as assigned.11. Demonstrates the I CARE values in the course of carrying out responsibilities.12. Follow all safety rules while on the job. Reports accidents promptly and corrects minor safety hazards.Experience - External:EDUCATION REQUIREMENTS Bachelors degree in Healthcare Administration, Business Administration, or other relevant field. Masters degree preferred.EXPERIENCE REQUIREMENTSFive plus years of progressively responsible experience in project and/or operations management with at least 5 years in a healthcare organization. Previous experience in a clinical setting and/or with direct physician interaction. Experience in directing the work of others to accomplish goals.CERTIFICATES, LICENSES AND REGISTRATIONS REQUIREDCPMSM or CPCS certification is a plus.SPECIAL KNOWLEDGE, SKILLS AND ABILITIES REQUIREDKnowledge of accrediting and credentialing requirements and associated practices. Ability to utilize information systems for tracking, monitoring, and analysis. Ability to effectively communicate (verbal and written) with various clinical and non-clinical audiences.