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Position Classification Description

Position Class Code / Title: A6027 / CVO Credentialing Manager
Recruitment Tier: Tier 1
FLSA: Exempt
Grade: 13

This is a description of a Staff Position Classification. It is not an announcement of a position opening. To view descriptions of current openings, please go to UNMJobs and Search Postings to view positions that are currently accepting applications.

The following statements are intended to describe, in broad terms, the general functions and responsibility levels characteristic of positions assigned to this classification. They should not be viewed as an exhaustive list of the specific duties and prerequisites applicable to individual positions that have been so classified.

Summary

Under limited supervision, oversees the operations of the UNM Health System Centralized Verification Office (CVO) to develop, manage and monitor processes and procedures that support the credentialing, re-credentialing, expirables data management, and delegated credentialing contract processes. Oversees all of the credentialing functions including application management and primary source verification. Ensures compliance with the appropriate accrediting and regulatory agencies. Supervises credentialing staff in the day-to-day management of the overall CVO credentialing process and database management. This title is reserved for UNM Health System Centralized Verification Office (CVO).

Duties and Responsibilities

  1. Manages the CVO credentialing process for all UNM Health System clinical providers, in accordance with, TJC, DNV, AAAHC NCQA, URAC, and CMS accreditation standards, Federal and State laws, and University policies.
  2. Coordinates the management the credentialing database and associated modules, ensuring accuracy of data and reporting to downstream systems. Monitors critical data for extensive analysis and report generation.
  3. Coordinates the management of the electronic credentials application, to ensure distribution, receipt, processing, and timely delivery to health system entity.
  4. Coordinates the management of the expirables process to ensure all clinical provider licenses and certificates remain current, ensuring appropriate notification prior to expiration.
  5. Monitors and reports turnaround times for processing of credentials applications, with continued focus on delivery of a high quality product, with the greatest efficiency, in the least amount of time,
  6. Monitors the currency of UNM Health System entity-specific medical staff bylaws, rules and regulations, and policies and procedures, ensuring compliance with accrediting organization requirements; participates in development and review of CVO Operating policies and procedures, Managed Care Delegated Credentialing policies and procedures; develops, recommends, and/or implements changes, revisions, and enhancements as appropriate to current operating environment.
  7. Provides on-site consultations across UNM with regards to credentialing practices and services; prepares and conducts credentialing orientations and provides updates as appropriate on new policies and procedures.
  8. Analyzes TJC, DNV, AAAHC, NCQA, URAC, and CMS standards and develops criteria to ensure compliance; revises general aspects of credentialing and privileging process as necessary; makes recommendations for and implements changes in policies and procedures.
  9. Prepares for and coordinates credentialing audits in compliance with the managed care delegated credentialing contracts.
  10. Functions as primary CVO credentials contact for all internal and external inquiries; develops and maintains positive working relationships.
  11. Oversees the supervision of personnel, which includes work allocation, training, promotion, enforcement of internal procedures and controls, and problem resolution; evaluates performance and makes recommendations for personnel actions; motivates employees to achieve peak productivity and performance.
  12. Represents the CVO to internal and external customers as appropriate; makes presentations to and interacts with various internal and external customers on issues pertinent to area of specialty.
  13. Performs miscellaneous job-related duties as assigned.

Minimum Job Requirements

  • Successful completion of at least 60 college-level credit hours; at least 5 years of experience directly related to the duties and responsibilities specified. Certification/Licensure NAMSS Certification as a Certified Professional Medical Services Manager (CPMSM) or Certified Provider Credentials Specialist (CPCS) or actively pursuing certification.
  • Completed degree(s) from an accredited institution that are above the minimum education requirement may be substituted for experience on a year for year basis.

Knowledge, Skills and Abilities Required

  • Ability to make administrative/procedural decisions and judgments.
  • Ability to investigate and analyze information and draw conclusions.
  • Ability to develop and deliver presentations.
  • Ability to process computer data and to format and generate reports.
  • Ability to supervise and train employees, to include organizing, prioritizing, and scheduling work assignments.
  • Ability to communicate effectively, both orally and in writing.
  • Ability to foster a cooperative work environment.
  • Strong interpersonal and communication skills and the ability to work effectively with a wide range of constituencies in a diverse community.
  • Skill in developing policy and procedure documentation.
  • Database management skills.
  • Employee development and performance management skills.
  • Knowledge of related accreditation and certification requirements.
  • Knowledge of medical credentialing and privileging procedures and standards.
  • Knowledge of medical staff policies, regulations, and bylaws and the legal environment within which they operate.
  • Knowledge of budget preparation

Conditions of Employment

  • Must maintain certification status.
  • Must obtain certification within one (1) year date of hire.

Working Conditions and Physical Effort

  • No or very limited physical effort required.
  • No or very limited exposure to physical risk.
  • Work is normally performed in a typical interior/office work environment.

The University of New Mexico provides all training required by OSHA to ensure employee safety.

Revised Date: 03/20/2017