Company :
Allegheny Health Network
Job Description :
GENERAL OVERVIEW:
This job is responsible for the development and execution of key strategic and operational activities related to Medical Staff services including credentialing, privileging and provider enrollment functions. Supports executive leadership with a range of activities essential to AHN's overall direction including the development and implementation of a network-wide physician organization. The incumbent is responsible for the successful definition, implementation and delivery of complex programs that requires cross-functional collaboration and interdependencies. This includes, but is not limited to, providing analytical/strategic-thinking and leadership support that enables the leadership team to isolate business issues and drive progress towards achievement of the Allegheny Health Network goals. Acts as a strategic and operational resource that interacts closely with the Executive Leadership and Division Chiefs of each Service Line to ensure continued growth. Manages all aspects of AHN's network credentialing process including Primary Source Verification, Privileging and Payor Enrollment. Manages all medical staff governance processes including oversight of the network Credentials Committee, Bylaws Committee, Professional Affairs Committee and the Medical Research, Education and Affairs committee of the AHN Board of Directors. This role requires the ability to work effectively in a fast paced, team oriented, highly visible environment where tasks are often sensitive and confidential in nature.
ESSENTIAL RESPONSIBILITIES
Manage AHN's network wide credentialing, privileging and enrollment functions.
Responsible for all aspects of the credentialing, re-credentialing and privileging processes for all medical providers who provide patient care at AHN hospitals and ambulatory surgery centers (ASCs).
Ensure providers are credentialed, appointed, and privileged with hospitals, patient care facilities and health plans.
Maintain up-to-date data for each provider in credentialing databases and online systems; ensure timely renewal of licenses and certifications. Enroll all employed Allegheny Clinic providers with participating insurance companies and ensure compliance with all government payer regulations.
Work closely with the Central Verification Office, Payer Enrollment and Privileging departments to optimize business processes and establish a collaborative, efficient process.
Facilitate the administration and governance of the Medical Staff functions.
Implement system-wide process enhancements to standardize process and eliminate duplicative processes across AHN's 7 hospitals and 4 ASCs.
Streamline all governance-related documentation including AHN's Medical Staff By-laws, Credentialing, Privileging and Peer Review policy, Medical Staff Organization and Functions Manual, hospital-specific Medical Staff Rules and Regulations, and other medical staff policies.
Work with department chairs and division directors in the design, development and maintenance of medical staff development plans and privileging documentation.
Assist in the identification and discipline for providers not adhering to AHN standards.
Standardize set of core AHN materials to facilitate the onboarding of employed and independent practitioners practicing in AHN facilities.
Develop consistent training program for both employed and private providers.
Standardize approach for the collection and management of medical staff dues.
Maintain Allegheny Health Network physician and ancillary provider data sets.
Formalize AHN processes and procedures for managing provider demographics information for all employed and aligned physicians and facilities.
Coordinate with Highmark Provider Relations to ensure consistent application of alignment rules.
Establish validation processes for downstream uses including Epic, Care Alignment Reporting, Intellicred, and marketing/web tools.
Assess risks that might jeopardize successful achievement of the desired results of a program, develop risk mitigation strategies and tactics, and implement risk mitigation plans.
Monitor and evaluate the progress, alignment and financial "health" of a cross-functional group of projects and related activities which together.
Other duties as assigned.
QUALIFICATIONS:
Minimum
Bachelor's Degree in Business Administration, Healthcare Administration or related field
10 years in a large corporate setting with strong emphasis on Strategic Planning and Communications with executive level positions
7 years in a management role
?
Preferred
Master's Degree in Business Administration, Healthcare Administration or related field
CPMSM and/or CPCS certifications obtained or in progress
Has a track record for developing successful business and strategic plans in highly competitive market
Knowledge of Healthcare industry strategies, Insurance operations and financing, clinical delivery, and/or ancillary products
Applied experience in provider, IDN or Clinical Delivery
Evidence of continuing additional education and coursework
Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.
Compliance Requirement : This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.
As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company's Handbook of Privacy Policies and Practices and Information Security Policy.
Furthermore, it is every employee's responsibility to comply with the company's Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.
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Req ID: J263578
