Required Qualifications (as evidenced by an attached resume):
Bachelor’s degree (foreign equivalent or higher). Three (3) years of full-time experience working in a healthcare delivery environment and/or managed care setting. Two (2) years of full-time experience in provider enrollment and/or credentialing activities with health insurance companies, healthcare provider organizations, or governmental health services organizations. Knowledge of Centers for Medicare & Medicaid Services (CMS), National Committee for Quality Assurance (NCQA), Certificate of Public Advantage (COPA), The Joint Commission (TJC), and/or State and Federal regulations. Two (2) years of full-time experience in healthcare compliance with Federal and/or State health care laws. Proficiency in Microsoft Office Suite.
Preferred Qualifications:
Advanced degree (foreign equivalent or higher) in healthcare related field. Professional credentialing certification: Certified Professional Medical Services Management (CPMSM) or Certified Provider Credentials Specialist (CPCS). Proficient in web-based credentialing software (i.e., Cactus, CAQH, ADA CAQH ProView etc.).
Position Overview:
The Credentialing & Compliance Manager is responsible for verifying that the credentials of the School of Dental Medicine (SDM) workforce (i.e., dental students, residents, faculty, volunteers, and staff), affiliates, and vendors adhere to the Commission on Dental Accreditation (CODA) standards, SDM Credentialing Policy and Article 28 DTC regulation relating to the SDM’s Dental Care Center (DCC). The position will compile, maintain, and verify provider enrollment and credentialing to ensure the SDM has a practitioner network of the highest quality. Once providers are active, the Manager will ensure that credentials are reverified as required and that educational requirements to maintain licensure and certification are met.
The Manager will oversee the implementation of the Cactus (i.e., Symplr) credentialing software/system. This will be a significant undertaking. The manager will be expected to consider related process improvements, enhancements and quality assurance testing of the system before production. The Manager will lead the SDM Credentialing Committee.
Credentialing requirements include but are not limited to: Degrees, Advanced Specialty Certification, NYS License Registration Certificate, DEA Registration Certificate, Vaccination Confirmations, Medical Clearance, ACLS/BLS/PALS Certificate, NYS Infection Control Certificate.
Educational Requirements include but are not limited to: Product Calibration, DCC Infection Control, Hazard Communication, Bloodborne Pathogens, Opioid Prescriber Training Part I and II, and SDM Policies & Procedures.
Compliance requirements include but are not limited to: SDM Faculty and Staff Annual HIPAA and Compliance Training and personnel requirements for State University of New York (SUNY) and NYS Article 28 DTC workforce.
Reporting to the Human Resources Business Partner, the Manager will assist in the development of innovative solutions to streamline the SDM Credentialing & Compliance processes, which will include creating job posting templates faculty and staff that outline the necessary compliance, credentialing, and educational requirements for the SDM and the SDM DCC.
Position Responsibilities:
General Oversight
* Provide clear insight and guidance regarding credentialing policies, best practices, and strategies for managing SDM credentialing, compliance, and educational requirements.
* Monitor the provider credentialing functions to assure that all providers are credentialed in accordance with established deadlines; monitor vendor credentialing; in accordance with New York State Department of Health (NYSDOH), Centers for Medicare & Medicaid Services (CMS), University polices, accreditation standards, and contractual agreements.
* Responsible for maintaining up to date knowledge of credentialing and legal requirements that may affect the credentialing program at the SDM.
* With guidance from leadership, develop credentialing workflow and coordinate with stakeholders to ensure required credentialing and clinical provider enrollment documents for onboarding and reappointment are met.
Credentialing Committee Responsibilities
* Maintain schedule of meetings, notification of members and management of agenda items, action items and follow ups.
* Assess activities on at least an annual basis in a report to the committee.
* Provide a regular summary report of SDM wide compliance, highlighting areas of concern and recommended solutions to the Executive Committee.
Provider Credentialing/Primary Source Verification
* Engage in direct correspondence, document telephone verification, secure electronic verification from the original verification source, or reports from the Credentials Verification Organizations (CVOs) that meet NYS regulatory and CODA accreditation requirements.
* Responsible for ensuring complete Primary Source Verification (PSV) for all providers.
* Confirm that an individual possesses a valid NYS license, certifications and other requirements/registrations to supervise the clinical education of students and residents.
* Communicate with the provider and give a clear overview of SDM requirements, expectations and timing.
* Evaluate employee file for identification of negative and/or adverse information identified during credentialing/re-credentialing, enrollment, or exclusion screening process. Notify the Dean/Chair as appropriate.
* Maintain all related records on candidate’s confirmation of primary source verification and other required documents not limited to state licensing boards, National Practitioner Data Bank, educational institutions, and peer references.
* Send weekly update reports to division contacts (Chair and Asst Chair) on verification status.
* Under the direction of the HR Business Partner, contribute to making sure required credentialing items are included in job postings accordingly.
* Send notification to department chairs that newly hired faculty have completed the credentialing process and are able to assume clinical teaching and patient care duties.
On-Going Compliance and Provider Maintenance
* Compile, review and coordinate the data for Council of Affordable Quality Healthcare (CAQH) applications including ADA CAQH ProView, and Cactus, as needed.
* Ensure that the SDM workforce adhere to the SDM Credentialing/Re-credentialing Policy.
* Maintain credentialing/recredentialing and provider enrollment for Medicaid/Medicare and other insurance providers for the SDM DCC facility.
* Follow and implement the provider credentialing and enrollment policies and procedures of SDM, the accrediting bodies, federal and state regulatory agencies.
* Implement CODA, National Committee for Quality Assurance (NCQA) & Centers for Medicare & Medicaid Services (CMS) guidelines as they pertain to credentialing.
* Develop tools and tracking documents as requested by divisions, credentialing and privileging committee and administration.
* Consider and implement new methods to expedite the compliance process.
* Respond to audit requests from the Dir of Health Science School Compliance.
* Coordinate with the Revenue Cycle Management Unit on effective cross-functional clinical provider enrollment and credentialing processes for contractual compliance for clinic providers.
* Ongoing compilation, monitoring, verification, and database maintenance of practitioner expirable credentials, including but not limited to license, DEA registration, board certification, and ACLS/BLS/PALS and/or CPR certification in accordance with all applicable regulatory standards.
* Responsible for tracking deadlines to ensure all licensing, professional liability, and verifications are current and providing timely updates.
* Maintain the integrity of the credentialing files by continuously auditing the data that is collected, distributed and entered into the electronic credentialing database (Cactus).
* Ensure that all required educational modules are completed by providers as required.
Cactus System Management
* Lead the implementation of the Cactus system.
* Present design options to the Credentialing Committee for consideration along with recommendations.
* Create and document procedures for system use, management and history of implementation and relevant modifications.
* Communicate project status and compliance statistics to stakeholders.
* Participate in the development and testing of ongoing Cactus (credentialing software) work processes and fully engage in the processes once developed.
Other
* Participate in the development and implementation of departmental policies and procedures.
* Participate in SDM events as requested.
* Other duties as appropriate based on rank and departmental mission.
Special Notes:
This is a full-time appointment. FLSA Exempt position, not eligible for the overtime provisions of the FLSA. Minimum salary threshold must be met to maintain FLSA exemption.
In addition to the employee’s base salary, this position is eligible for $3,026 UUP annual location pay, paid biweekly.
Essential Position: This has been designated as an essential position based on the duties of the job and the functions performed. Positions that are designated as such may be required to report to work/remain at work even if classes are canceled, and the campus is working on limited operations in an emergency.
For this position, we are unable to sponsor candidates for work visas.
THE FOLLOWING PARAGRAPH ONLY APPLIES TO POSITIONS THAT MAY COME IN CONTACT WITH PATIENTS OR PATIENT CARE EMPLOYEES.
In response to the New York State Department of Health (DOH) regulation requiring Hospital and Nursing Home personnel to be fully vaccinated against COVID-19, candidates selected for patient care positions or positions that may come in contact with patients or patient care employees, if not already vaccinated, must be fully vaccinated or obtain the first dose of the vaccine within three (3) calendar days of acceptance of conditional job offer and must obtain any subsequent doses in accordance with the DOH vaccine protocol. Candidates who are partially vaccinated, but not yet fully vaccinated, must complete their vaccination series within three (3) calendar days of job offer or in accordance with vaccine manufacture protocol, whichever comes later. The regulation also allows for limited exemptions with reasonable accommodations, consistent with applicable law.
Resume/CV and cover letter should be included with the online application.
Stony Brook University is committed to excellence in diversity and the creation of an inclusive learning, and working environment. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, sex, pregnancy, familial status, sexual orientation, gender identity or expression, age, disability, genetic information, veteran status and all other protected classes under federal or state laws.
If you need a disability-related accommodation, please call the university Office of Equity and Access (OEA) at (631) 632-6280 or visit .
In accordance with the Title II Crime Awareness and Security Act a copy of our crime statistics can be viewed.
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