We believe we are more than a job at Yakima Valley Farm Workers Clinic. We're an FQHC committed to providing patient-centered care to communities. Compassion is at the core of our approach. We treat patients according to their preferences, regardless of location, origin, or ability to pay. Our doors are open to all, regardless of their citizenship status.
We serve over 197,000 patients across 28 medical clinics, 15 dental clinics, 11 pharmacies, and 49 program sites in two states. We are Level 3 Certified as a Patient-Centered Medical Home (PCMH). With integrated services including medical, dental, pharmacy, orthodontia, primary care nutritional counseling, autism screening, and primary care behavioral health, YVFWC's patient-centered model of care offers patients the full spectrum of care and shelter assistance, energy assistance, weatherization, HIV and AIDS counseling and testing, home visits, and four mobile medical/dental clinics.
The Senior Manager of Professional Staff Services oversees credentialing processes for healthcare professionals, ensuring compliance with accreditation standards, laws, and regulations. Responsibilities include developing and managing credentialing policies, conducting internal audits, and serving as a resource on credentialing matters. Qualified candidates should possess intermediate to advanced knowledge of credentialing principles and regulatory standards, including FPPE, OPPE, and Peer Review. They should demonstrate leadership skills, the ability to interpret and apply relevant laws and regulations independently, and proficiency in database software and reporting. Strong attention to detail, discretion with confidential information, and effective collaboration with medical professionals are essential. This position offers the opportunity to lead a team, shape organizational policies, and contribute to the quality and efficiency of professional staff services.
What We Offer
Salary$71,000-$93,000DOE with ability to go higher for highly experienced candidates.
100% employer-paid health insurance for employees including Medical, Dental, Vision, Rx, 24/7 telemedicine; profit sharing, 403(b) retirement plan, generous paid time off, paid holidays, and more.
Relocation allowance is available.
Essential Functions/Responsibilities/Duties
Develops, implements, and manages credentialing processes for all LIPs, OLCPs and facilities in accordance with CMS accreditation standards, Federal and State laws, payer requirements, and all applicable external regulatory bodies.
Researches, develops, implements and updates policies and procedures in support of Professional Staff processes, to include peer review, disruptive/impaired Providers, ongoing/focused professional practice evaluation, and training of residents.
Develops, implements, and maintains effective policies, procedures, and processes for credentialing Providers in educational settings or post-graduate medical education programs.
Oversees credentialing workflows and/or services provided by third party vendors as appropriate.
Conducts all aspects of third-party credentialing for Providers and facilities in accordance with CMS, FQHC (Federally Qualified Health Center) and third-party insurance standards.
Provides guidance and support to new Providers through the credentialing process, from initial application to Provider roster loading.
Conducts internal audits and works directly with health plans to undergo annual audits and provide routine reports to Administration / payers.
Monitors and reports key performance indicators for the team to include turnaround times for processing credentials applications, with a continued focus on delivery of a high-quality product, with the greatest efficiency, in the least amount of time.
Manages relationships with our NCQA-certified Credentials Verification Organization (CVO) and other external stakeholders.
Serves as the Subject Matter Expert (SME) and resource to the Credentials Committee, Senior Leadership and the YVFWC Board of Directors as it pertains to credentialing and payer enrollment related responsibilities.
Maintains a comprehensive understanding and serves as the SME for nuances of licensure, enrollment, and credentialing requirements across health plans.
Demonstrates an understanding of and proficiency with the application of all compliance and reporting requirements respective to Joint Commission Certification (JCC) standards.
Educates external and internal business partners on market movement that influence and impact work including current and proposed government or regulatory policy, reimbursement landscape, payer trends, and potential legal considerations of the credentialing process.
Manages and ensures optimization of credentialing-based software system.
Files applicable Provider practice change notifications and performs follow up duties until confirmed complete by payers.
Advises, drafts, and completes appropriate reporting to State and Federal agencies with respect to adverse professional staff actions, to include the states of Washington and Oregon as well as the National Practitioner Data Bank.
Collaborates with multidisciplinary teams to investigate the disciplinary process for Providers and offers all applicable outcome options for consideration to applicable parties.
Collaborates with the Recruiting, Operations, and Human Resources (HR) departments to ensure timely and appropriate practices in the hiring and onboarding of new Providers at YVFWC.
Maintains processes for granting of temporary and disaster privileges, as necessary, in accordance with regulatory and accreditation standards.
Manages all aspects of the Fair Hearing Process as outlined by YVFWC policy, accreditation standards and federal law.
Demonstrates appropriate management of all delegated credentialing functions for which YVFWC is involved, to include audits, surveys and ongoing information sharing and updates.
Applies advanced knowledge of regulatory and accreditation standards such as The Joint Commission (TJC), National Committee for Quality Assurance (NCQA), Centers for Medicare & Medicaid Services (CMS), Health Resources and Services Administration (HRSA) to ensure continued compliance in all matters pertaining to professional staff services.
Manages, supervises, and mentors direct report staff. Provides continuous performance management and conducts employee performance evaluations. Addresses performance and/or behavior issues, clarifying expectations and providing feedback.
Supports staff growth and development. Assesses the educational and experience needs of all levels of staff in collaboration with the individual. Encourages staff to seek educational opportunities incorporating job related training in addition to mandatory training.
Participates in the recruitment and selection of staff. Provides orientation to outline job requirements and expectations, policies and procedures, and proper use of tools and equipment.
Performs other duties as assigned.
Qualifications
Education: Bachelor's Degree in Business Administration, Healthcare, Healthcare Administration, or Healthcare Management. Associate's Degree and two additional years of relevant experience may be substituted for a Bachelor's Degree. High School Diploma or GED and four additional years of relevant experience may be substituted for a Bachelor's Degree.
Experience: Five years' experience in credentialing, payor enrollment, and/or health plan enrollment. Two of these years must be in an ambulatory setting and at least two years spent holding the certification(s) listed below. Two years' supervisory experience in a credentialing and/or payor enrollment setting, which can occur concurrently with the experience above.
Professional Licenses/Certificates/Registration: One of the following is required, two is preferred:
Certified Provider Credentialing Specialist (CPCS)
Certified Professional Medical Services Management (CPMSM)
Provider Enrollment Specialist (PESC) certificate
Knowledge/Skills/Abilities Required: Intermediate to advanced knowledge of principles pertaining to Focused Professional Practice Evaluation (FPPE), Ongoing Professional Practice Evaluation (OPPE) and Peer Review. Advanced knowledge of National Practitioner Data Bank (NPDB), NCQA, TJC, CMS and State Laws and regulations as they pertain to credentialing, Provider enrollment, and Peer Review. Exercises independent judgement in interpreting NPDB, NCQA, TJC, CMS and State Laws and regulations as they pertain to credentialing. Effectively leads and manages a department and a team. Skills to create departmental and organizational policies and procedures. Skills to direct investigations and resolve issues of high importance and sensitivity. Skills to be innovative, establish priorities, and make decisions independently. Knowledge and skills to work with database software and independently generate reports. Prioritizes work, handles a variety of tasks simultaneously, and completes projects in a fast-paced environment. Works effectively in an environment with frequent interruptions. Skills to handle sensitive situations and confidential information with discretion. Effectively collaborates with medical professionals in a team framework. Exercises independent judgement and solid decision making. Strong attention to detail and high level of accuracy. Effective verbal, written and listening communication skills. Intermediate proficiency with a variety of computer programs including Microsoft Outlook, Word, Excel, and PowerPoint.
Working at YVFWCWorking in our organization means being the passionate champion for those who have no voice. It means having the opportunity to work with underserved populations and with peers committed to the same work.At Farm Workers Clinic
We will consistently trust one another to work for the common good.
We will foster integrity by demonstrating ethical behavior and insisting on doing what we say we will do.
We will demonstrate transparency by being candid and truthful no matter the risk.
We will create partnerships to strengthen ourselves and our community.
We will fight for just treatment for all individuals.
We will let joy in.
We have the courage to be an agent of change and refuse anything short of excellence.
Our mission celebrates diversity. We are committed to equal opportunity employment.PI236861379 Apply
