Associate Director, Credentialing Operations

Job Description

It’s Time For A Change...

Your Future Evolves Here

Evolent Health has a bold mission to change the health of the nation by changing the way health care is delivered. We bring our whole selves to work and we’re driven to make a difference every day, from the work we do in our roles to the charitable endeavors we support. We believe in starting by listening, communicating with candor, fostering inclusion and owning the opportunity. We respect and celebrate individual talents and team wins. Whether we’re wearing scrubs, jeans or our finest work-from-home chic, we have fun, work hard and make time to help others.

Are we growing? Absolutely. We have seen about 30% average growth over the last three years. Are we recognized? Definitely. We were named one of “Becker’s 150 Great Places to Work in Healthcare” in 2016, 2017, 2018 and 2019 and are proud to be recognized as a leader in driving diversity, equity and inclusion (DE&I) efforts. Evolent achieved a 100% score on the 2020 Human Rights Campaign's Corporate Equality Index, making us one of the best places to work for LGBTQ+ employees. We were also named on the Best Companies for Women to Advance List 2020 by Parity.org and we publish an annual Diversity Report to share our progress on how we’re building an equitable workplace and performing on various metrics. If you’re looking for a place where your work can be personally and professionally rewarding, don’t just join a company with a mission. Join a mission with a company behind it.

What You’ll Be Doing:

Evolent Health is looking for an Associate Director, Credentialing Operations to be a key member of the Provider Data Management team. Reporting to the Senior Director, Credentialing Operations and Provider Data Management, this individual will play a critical role in executing Evolent Health’s mission by working directly with our partners, focused on coordinating, monitoring, trending and supporting report requirements of business operational and clinical programs within Provider Data Management. The Associate Director, Credentialing Operations will work with both internal and external business partners to implement ongoing operational monitoring, resolve service barriers, develop solutions to improve effectiveness and identify continuous improvement initiatives to increase service and operational level agreements.

• Provide leadership and management expertise to the Credentialing Department, which includes supervision of direct reports.
• Plan, organize, direct, and effectively manage the responsibility for overseeing the day-to-day operations of the Credentialing team by creating a positive environment that encourages staff to perform at their highest potential.
• Create, manage, and utilize inventory management processes, to include reporting and analysis to ensure effective decision making, triaging and assignment of work to department associates, resulting in meeting or exceeding internal and company partner key performance metrics, key performance indicators and turnaround times.
• Effective operational leadership experience, which includes proficiency in highly visible and critical role with top notch communication skills serving a wide variety of internal and external clients.
• Responsible for hiring, training, coaching, reviewing job performance and counseling all direct report staff. Provides coaching to employees when needs are identified, holding employees accountable for results through coaching and development of action plans.
• Ensure department standards by efficiently setting goals and objectives, assisting with the prioritization of work, using available resources.
• Initiate and facilitate the Credentialing and Recredentialing process on behalf of company partners within tight timelines, meeting company partner, accreditation, and regulatory standards.
• Communicate regularly with partners and knows when and how to appropriately escalate issues for resolution.
• Communicate key performance data and action plans to leadership, including participation in Command Center Operations Management (CCOM) and partner operations meetings.
• Maintain and analyze department statistics on work volume, productivity, and accuracy for use in strategic, long-range planning.
• Effectively delegate duties in order to manage productivity and effectively manage time.
• Effectively perform due diligence and research and establishes solutions to bridge gaps in work processes.
• Work without boundaries and advances knowledge of processes outside of the immediate job responsibilities. Maintain positive leadership and provide frequent performance feedback and encourages positive participation and feedback among the team members.
• Provide a collegial environment which fosters teamwork within the department’s team as well as other cross functional departments.
• Prepare key credentialing operational reports for internal and external partners that drive effective and efficient business decisions and impact strategic planning.
• Maintain comprehensive knowledge of both state and federal statutory requirements to ensure that all legal, licensure and accreditation standards, due dates and deadlines are met.
• Assure credentialing activities are integrated and administered by the department in partnership with partner Credentials and Quality Management Operational Committees (QMOC).
• Work with senior leadership to support and lead certification and accreditation processes with the National Committee for Quality Assurance (NCQA), both internally and to support company partners.
• Primary company partner delegated group representative, responsible for organizing and performing pre-delegation and annual delegation oversight functions, provider credentialing files audits and generating summaries for presentation and decision.
• Develop and maintain quality assurance and audit functions to ensure credentialing processes meet statutory and accreditation guidelines and standards.
• Serve as an expert in the administration and maintenance of credentialing and provider data management systems, including the Council for Affordable Quality Healthcare (CAQH), IntelliSoft and proprietary claim systems.
• Perform all other duties, as assigned.

The Experience You’ll Need (Required):

• High school graduation or completion of General Equivalency Degree/Diploma (GED)
• Three (3) to five (5) years of credentialing and/or provider enrollment leadership experience with physicians, Advance Practice Clinicians (APCs), behavioral health, and/or allied providers, in a fast-paced health care environment (hospital, provider group, health plan)
• Prior and progressive supervisory and leadership experience
• Experience working within a health plan, managed care organization, provider operated healthcare environment or Third-Party Administrator (TPA)/Business Process Outsourcing (BPO)
• Extensive knowledge of computers and related software applications, such as Word, PowerPoint, Excel, Project
• Demonstrated exceptional active listening and communications skills

Finishing Touches (Preferred):

• Bachelor’s degree
• Certified Provider Credentialing Specialist (CPCS) and/or Certified Professional Medical Staff Management certification

Technical requirements:

Currently, Evolent employees work remotely temporarily due to COVID-19. As such, we require that all employees have the following technical capability at their home: High speed internet over 10 MBPS and, specifically for all call center employees, the ability to plug in directly to the home internet router. These at-home technical requirements are subject to change with any scheduled re-opening of our office locations.

Evolent Health is an equal opportunity employer and considers all qualified applicants equally without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran status, or disability status.