Quality Compliance Manager at TeleSpecialists LLC – Brookhaven, Georgia
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About This Position
This is an in-office position based at our Brookhaven, Atlanta office.
About Us:
TeleSpecialists is transforming healthcare delivery as the nation's largest and fastest-growing digital healthcare leader. By providing expert neurological and psychiatric care directly to over 400 hospitals and health systems across the country, we don't just provide care; we pioneer solutions that make quality healthcare easily accessible.
Join a team where your passion meets our purpose. If you’re inspired by innovation, thrive in a collaborative and entrepreneurial environment, and want to be a part of a team that’s reshaping the future of patient care, we want you on our team. At TeleSpecialists, you'll discover more than just a job. You will be able to experience meaningful work, accelerated career growth, and the opportunity to redefine healthcare for the future.
Tele Specialists Offers:
- A great culture with a team environment
- A fun, diverse work environment
- A rapidly growing company with career advancement opportunities
- Medical, Dental and Vision benefits
- Tuition Reimbursement
- 401k match
- Paid Vacation
- Leadership Training Classes
- Mentorship Program
About the Role:
The Credentialing & Licensing Regulatory Compliance Manager is responsible for ensuring TS policies and procedures meet and abide by the proper credentialing and licensing of providers to be compliant of The Joint Commission (TJC), National Committee for Quality Assurance (NCQA), and medical state licensure regulations and certifications. Manage the QA Audits from each department within the C&L division and monitor areas for additional education along with process improvements.
Essential Duties and Responsibilities:
- Monitors and manage updates on regulatory state licensing guidelines, and standardization of credentialing in meeting NCQA and TJC requirements for all departments.
- Review and manage credentialing & licensing policies and procedures update process
- Ensure established processes and procedures are monitored
- Analyze trends allowing for proper development of materials for regulatory and compliance
- Review and manage the audit process of at least 5% to 10 % of providers’ files for quality assurance
- Utilize reports and dashboards to ensure regulatory, quality, and compliance against established processes, deadlines, and metrics
- Coordinate the monthly regulatory & compliance educational sessions for credentialing and licensing staff
- Identify opportunities for improvement to increase quality, compliance, effectiveness, and efficiency
- Facilities annual review and update of applicable governing documents (bylaws, credentialing policies, rules, DOPs) that support and direct organizational practices and ensure compliance
- Works with C&L leadership to create, maintain, and analyze job work instructions for the efficiencies of the division while utilizing the credentialing software
- Ability to assume responsibility and exercise good judgement in making decisions within the scope of authority of the position
- Must demonstrate and promote a positive collaborative environment
- Assist with certification surveys for NCQA, TJC, ISO, and any other efforts regarding credentialing
Qualifications:
- Certified Provider Credentialing Specialist (CPCS) and/or Certified Professional Medical Ser-vices Management (CPMSM) required
- Quality & Compliance experience required
- Experience with Credentialing Accreditation by The Joint Commission and/or National Committee for Quality Assurance required
- Credentialing experience required
- Physician licensure experience preferred
- BA/BS preferred or equivalent
Knowledge, Skills, and Abilities:
- Values and models integrity and honesty by acting in a just, fair, and ethical manner and encouraging ethical behavior, among others. Inspires trust and confidence among stakeholders through reliability, authenticity, and accountability
- Establishes productive, cooperative relationships with subordinates, peers, management, and stakeholders both internal and external to the organization.
- Understands and responds to others’ needs and priorities.
- Gives and seeks feedback that will increase the productivity of relationships and networks with peers and associates to build a support base
- Manage multiple tasks, meet deadlines, and prioritize multiple projects that require detail-orientation
- Ability to interact with internal and external customers
- Flexible and adaptable in learning and understanding new technologies
- Highly analytical and detail-oriented with ability to demonstrate command of details and to articulate those details at a higher level.
- Strong written, oral, and interpersonal communication skills
- Highly self-motivated, directed, and initiative-taking
- Keen attention to detail
- Ability to effectively prioritize and execute tasks in a high-pressure environment
- Able to communicate effectively within department and with members of interdisciplinary teams
- Ability to work independently and proactively in a fast-paced environment
- Proven analytical and problem-solving skills
Travel Requirements (if applicable):
- Travel (15%)
Other Duties:
This job description is not intended to be an exhaustive list of all duties, responsibilities, or qualifications associated with the position. Duties, responsibilities, and activities may change or be assigned at any time based on business needs.
Physical Requirements:
- Must be able to remain in a stationary position (sitting or standing) for prolonged periods, often up to 75% of the workday.
- Needs to occasionally move about inside the office to access file cabinets, office machinery, or shared workspaces.
- Constantly operates a computer and other office productivity machinery, such as a calculator, copy machine, and printer.
- Must be able to exchange accurate information with clients and co-workers in person, over the phone, and via digital platforms.
- Occasionally moves or transports office supplies, files, or equipment weighing up to 25 pounds.
- Occasionally positions self to maintain files in cabinets or access equipment stored in low or high areas.
- Requires close visual acuity to perform activities such as preparing and analyzing data, transcribing, and viewing a computer monitor for extended periods.
Equal Employment Opportunity & ADA Statement
The Company is an equal opportunity employer and is committed to providing equal employment opportunities to all employees and applicants without regard to race, color, religion, sex, sexual orientation, gender identity or expression, national origin, age, disability, genetic information, veteran status, or any other status protected by applicable law. The Company will provide reasonable accommodations for qualified individuals with disabilities in accordance with applicable laws.
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Job Location
Job Location
This job is located in the Brookhaven, Georgia, 30329, United States region.