Senior Director, Physician Services

The Senior Director of Physician Services will lead and oversee all aspects of medical staff credentialing and payer enrollment processes across a large, multi-hospital health system with over 1,000 medical staff members and 100+ ambulatory practices. This role is crucial to ensuring the seamless onboarding, credentialing and enrollment of medical staff, enabling providers to deliver high-quality patient care. The senior director will work closely with key stakeholders across various departments, including Medical Staff, Human Resources, AtlantiCare Physician Group, AtlantiCare Health System Executive Leadership and other clinical and administrative teams.

The ideal candidate will bring extensive experience working with healthcare providers and a deep understanding of medical staff credentialing and payer enrollment processes. This individual will spearhead efforts to improve efficiency and quality within these processes, driving innovation and strategic transformation. They will also play a critical role in enhancing communication, ensuring regulatory compliance and delivering a superior provider experience.

Key Responsibilities:

1. Medical Staff Credentialing:

• Oversee the Medical Staff Credentialing Department, ensuring compliance with state, federal and accreditation standards (e.g., The Joint Commission, NCQA).
• Develop and implement policies and procedures to streamline credentialing and privileging processes.
• Ensure timely processing of applications for new providers and recredentialing for existing staff.
• Collaborate with Medical Staff leadership and committees to ensure adherence to bylaws and regulations.
• Monitor and report on key performance metrics related to credentialing timeliness and accuracy.

2. Payer Enrollment:

• Lead the payer enrollment process for all healthcare providers within the system, ensuring efficient and timely enrollment with government and commercial payers.
• Maintain relationships with payer representatives to address credentialing and enrollment issues.
• Ensure all provider information is accurate and up to date with payers, reducing claims denials and delays in reimbursement.
• Monitor changes in payer requirements and ensure organizational compliance.

3. Collaboration & Communication:

• Partner with Provider Recruitment and Onboarding teams to ensure a smooth and exceptional provider experience from recruitment through the first day of clinical practice.
• Build and maintain collaborative relationships across departments (e.g., Human Resources, Finance, Clinical Operations) to align credentialing and enrollment processes with organizational goals.
• Serve as a key liaison between Medical Staff leadership, Human Resources and administrative departments to communicate credentialing timelines and resolve issues promptly.
• Facilitate regular meetings with stakeholders to discuss process improvements and updates.

4. Process Improvement & Transformation:

• Evaluate current processes and systems used in credentialing and payer enrollment. Recommend and implement process improvements to enhance efficiency and provider satisfaction.
• Drive initiatives to adopt new technologies or systems that streamline workflows, improve data accuracy and enhance communication.
• Lead change management efforts to ensure successful implementation of process improvements.

5. Compliance & Quality Assurance:

• Ensure credentialing and enrollment processes comply with applicable state, federal and regulatory guidelines.
• Implement continuous quality assurance measures to maintain the highest standards of accuracy, timeliness and service excellence.
• Lead audits and prepare reports for internal and external regulatory bodies as needed.

6. Leadership & Team Development:

• Lead, mentor and develop a high-performing team of credentialing and payer enrollment professionals.
• Foster a collaborative and accountable team culture focused on operational excellence, professional growth and service excellence.
• Monitor staff performance, provide coaching and development opportunities, and ensure the team meets organizational goals.

Qualifications:

• Education: Bachelor's degree in healthcare administration, business administration or a related field required. Master's degree preferred.
• Experience: Minimum of 7-10 years of experience in medical staff credentialing, provider enrollment or healthcare administration, preferably within a large health system. Proven experience managing medical staff services and payer enrollment functions. Strong understanding of accreditation standards (e.g., The Joint Commission, NCQA), regulatory requirements and payer credentialing processes.
• Skills & Competencies: Strong leadership and team management skills. Excellent communication and interpersonal skills; ability to build relationships across departments. Ability to manage competing priorities in a fast-paced environment. Experience driving process improvements and implementing change management strategies. Strategic thinking and problem-solving capabilities. Proficiency with credentialing software and electronic health record (EHR) systems.

Key Competencies:

• Collaboration: Foster cross-departmental collaboration to enhance communication and streamline processes.
• Change Management: Lead transformative initiatives and drive continuous improvement within credentialing and payer enrollment processes.
• Operational Excellence: Maintain a focus on high-quality outcomes, efficiency and timely execution of credentialing and enrollment tasks.
• Communication: Exhibit strong verbal and written communication skills to ensure alignment across all stakeholders.

PERFORMANCE EXPECTATIONS
Demonstrates the technical competencies as established on the Assessment and Evaluation Tool.

WORK ENVIRONMENT
This position requires repetitive motion, fingering, hearing, pushing, reaching,  reading, calculating, seeing, speaking, standing and walking a majority of the time. This position also works with such equipment as a computer terminal, fax machine, copier and telephone. Occasional driving also required.

The essential functions for this position are listed on the Assessment and Evaluation Tool.

REPORTING RELATIONSHIP
This position reports to Assistant Vice President, People and Culture and supervises incumbents as assigned.

The above statement reflects the general details considered necessary to describe the principal functions of the job as identified and shall not be considered as a detailed description of all work requirements that may be inherent in the position.