At MTM, we are not just colleagues; we are collaborators on a shared mission;communities without barriers. We have exciting opportunities to join our growing team where your work has a direct impact on the communities we serve. Our company culture is one of innovation, collaboration, and growth. If you are passionate, driven, and ready to join a team where your work will directly transform and shape our industry, then we want to talk to you!

What will your job look like?

The Director, Credentialing Compliance is responsible for developing, executing and managing the compliance processes as it relates to the credentialing functions. It requires strong judgment skills and business acumen, as the successful management of Credentialing will be achieved by building and maintaining strong relationships with multiple internal and external team members and cross functional groups. This position will also be responsible for identifying regulatory compliance risks and related issues and partnering with internal teams to determine root cause and resolutions. The Director, Credentialing Compliance will need strong knowledge of CMS Regulations, client contractual requirements and excellent communication, interpersonal and organizational skills.

Location: This is a hybrid role of work from home and in office at our Lake St. Louis, MO location.

What youll do:

• Regulatory Compliance responsibilities as it relates to the credentialing process, include but are not limited to the following:
  • Prevention of unethical, illegal or improper conduct within the credentialing process
  • Monitoring activities of all aspects of the credentialing compliance requirements to identify possible trends both good and bad
  • Create and maintain policies and procedures to assure compliance with applicable local, state and federal laws, regulations and third-party guidelines
  • Manage audits and investigations into credentialing compliance issues
• Manage, develop and train the Credentialing personnel
• Provides day-to-day oversight, monitoring and analyses of all activities related to Organizational Quality Management in adherence to identified national standards i.e. National Committee for Quality Assurance (NCQA), Utilization Review Accreditation Committee (URAC) and HITRUST certification
• In concert with other MTM departments organize systematic data collection for analysis and interpretation of transportation and ancillary services and outcomes, including identification of transportation provider patterns and compliance with credentialing standards
• Provide oversight management of Quality Improvement Programs corporate wide
• Successful management of URAC accreditation and ongoing compliance as it relates to the credentialing process
• Promote continuous improvements in quality systems and department infrastructure
• Report significant and/or serious ongoing quality and credentialing deficiencies to senior/executive management, either by formal or informal presentations and corrective and preventive action plans
• Coordinating the development of risk assessments, audit plans and scopes for internal audits and compliance engagements
• Assisting with proposals for new business opportunities in the areas of credentialing compliance and best practices and related special projects

What youll need:

Experience, Education and Certifications:

• High School Diploma or G.E.D.
• Bachelors degree or equivalent work experience
• 12 years experience of Compliance or Credentialing Management
• 8 years experience in Quality Management
• Minimum of 5 years supervisory/management experience
• Experience in developing, writing and implementing SOPs

Skills:

• Demonstrate excellent time management skills
• Ability to work within a team-oriented environment
• Ability to identify, interpret and communicate business risks
• Ability to lead, coach and motivate a specialized compliance team
• Thoroughly understand various HIPAA laws
• Familiarity with health care legislation and standards for protecting PHI
• Detail oriented, with excellent communication skills
• Data analysis and interpretation skills
• Ability to schedule, organize and prioritize multiple tasks
• Knowledge of budgets and cost analysis preferred
• Moderate to advanced computer skills
• Excellent problem-solving skills with the ability to anticipate and resolve problems
• Ability to maintain positive attitude and team focused during high stress situations
• Ability to maintain high level of confidentiality
• Must be able to communicate with staff of all job levels professionally
• Regular attendance

Even better if you have...

• Certified Professional Health Care Quality (CPHQ) preferred
• Previous experience working with Medicaid and or State programs is preferred
• Experience working for a Managed Care Health Plan is preferred

Whats in it for you:

• Health and Life Insurance Plans
• Dental and Vision Plans
• 401(k) with a company match
• Paid Time Off and Holiday Pay
• Maternity/Paternity Leave
• Casual Dress Environment
• Tuition Reimbursement
• MTM Perks Discount Program
• Leadership Mentoring Opportunities

Salary Min: $90,720

Salary Max: $120,000

This information reflects the base salary pay range for this job based on current national market data. Ranges may vary based on the job's location. We offer competitive pay that varies based on individual skills, experience, and other relevant factors. We encourage you to apply to positions that you are interested in and for which you believe you are qualified. To learn more, you are welcome to discuss this with us as you move through the selection process.

Equal Opportunity Employer: MTM is an equal opportunity employer. MTM considers qualified candidates with a criminal history in a manner consistent with the requirements of applicable local, State, and Federal law. If you are in need of accommodations, please contact MTMs People and Culture.

Equal Opportunity Employer - minorities/females/veterans/individuals with disabilities/sexual orientation/gender identity