Great careers are built at Banner Health. We understand that talented health care professionals appreciate having options. We are proud to offer our team members many career and lifestyle choices throughout our network of facilities. Apply today, this could be the perfect opportunity for you.
Are you passionate about providing high quality and can create an environment of collaboration, with proven leadership skills? Do you want the chance to advance your career by joining a rapidly growing company? If you answered "yes" to any of these questions - this position sis for you! This is a rewarding position in an environment that will challenge you and give you opportunities to grow within a prestigious healthcare company.
Your pay and benefits are important components of your journey at Banner Health. Banner Health offers a variety of benefits to help you and your family. We provide health and financial security options so you can focus on being the best at what you do and enjoying your life.
Banner Health Network (BHN) is an accountable care organization that joins Arizona's largest health care provider, Banner Health, and an extensive network of primary care and specialty physicians to provide the most comprehensive healthcare solutions for Maricopa County and parts of Pinal County. Through BHN, known nationally as an innovative leader in new health care models, insurance plans and physicians are coming together to work collaboratively to keep members in optimal health, while reducing costs.
This position oversees, plans, organizes and coordinates all credentialing activities of Banner Health's credentialing. Functions as the lead in the implementation and development of Banner Health's practitioner and organizational credentialing processes. Through effective staffing and management of work functions, this position oversees the accurate, timely and cost-effective completion of credentialing activities to meet contractual federal requirements and State mandated regulations. This position also oversees that regulatory compliance related to credentialing requirements are followed.
1. Manages the operations of all aspects of credentialing for the Banner employed, and Community network practitioners and facilities. Develops, manages and maintains work processes, policies and procedures for credentialing to meet NCQA, URAC, State Medicaid and CMS requirements and standards.
2. Selects, trains, coaches, motivates, conducts performance evaluations, directs the workflow for the assigned Credentialing Supervisors that oversees credentialing staff and manage staff performance. Develops goals, metrics and performance expectations and holds them accountable.
3. Maintains compliance with all federal, state, NCQA accreditation, regulatory standards and health plan delegated contractual requirements related to the provider certification and credentialing. Responsible to, manage and monitor activities of department obligations to internal and external customers, auditors and regulators.
4. Collaborates with internal and external customers, auditors and regulators, including Banner Compliance, Managed Care, IT, Contracting, health plans, medical groups and other customers to develop and maintain business rules and relationships.
5. Develops, reviews and meets organization criterion related to credentialing operations, turnaround times, quality, regulatory and accuracy requirements, standards, processes and workflows for the department using and developing automation, where appropriate. Accountable for ensuring high performance outcomes through an integrated process of operational, quality and resource management.
6. Oversees special projects requiring knowledge of accreditation, NCQA, URAC. State Medicaid and CMS regulations and other requirements. Interacts with varied levels of management, physician office staff and practitioners effectively to accomplish satisfactory end results.
7. Supervises human and material resources needed to maintain or exceed department standards. Participates in the development of the department budget in conjunction with established goals and objectives.
8. Works independently under limited supervision. Manages all aspects of the function for the company. Has freedom to determine how to best accomplish functions within established procedures.
Performs all functions according to established policies, procedures, regulatory, accreditation standards requirements, as well as applicable professional standards. Provides all customers of Banner Health with an excellent service experience by consistently demonstrating our core and leader behaviors each and every day.
Must possess knowledge typically gained from the completion of a bachelor's degree in business or a related field or the equivalent training and experience.
Requires strong knowledge normally acquired over seven or more years of experience in health plan and managed care credentialing.
Must possess extensive knowledge of managed care operations, commercial insurance contracts, and governmental reimbursement methodologies. Must have demonstrated success in effective decision making in managing a diverse staff. Must possess strong computer skills including the ability to work with software and spreadsheets.
Experience with state and federal rules, regulations, CMS, URAC and NCQA standards is desired.
Additional related education and/or experience preferred.
Internal Number: R26510
About Banner Health
You want to change the health care industry – one life at a time. You belong here. You’re excited to be part of the dramatic changes happening in the health care field. In fact, you thrive on change. But you also understand that excellent, compassionate patient care is the true measure of the success of these changes. You belong at Banner Health. Our award-winning, comprehensive health system includes 23 hospitals in seven western states, primary care health centers, research centers, labs, a network of physician practices and much more. Throughout our system, skilled, compassionate professionals use the latest technology to change the way care is provided. If you’re looking to be a key contributor to a forward-looking organization, you’ll experience a wide variety of professional advantages: •Our vision for changing the future of health care gives you the opportunity to leverage your abilities to achieve something historic. •Our expansive system offers you an unmatched variety of clinical settings – from large urban trauma center to small rural hospital, ambulatory to home health. Our system also includes hospitals specializing in cancer, heart health and pediatrics. •Our many loc...ations also translate into a broad selection of exciting and rewarding lifestyle options – from the big city to the wide-open spaces. •Our commitment to healthcare innovation means you always have the latest technologies at your fingertips to help you provide the finest care possible. •The size, success and growth of our system provide you with the stability and options to pursue your desired career path. •Our competitive compensation and comprehensive benefits offer you options to complement your unique needs.