Medical Staff Credentialing Director is responsible for all aspects of the verification process for medical staff incumbents. Provides regulatory oversight and guidance to the credentialing process. Being a Medical Staff Credentialing Director maintains working knowledge and ensures continuing compliance with state, federal, and institutional standards and guidelines. Develops and implements policies and protocols related to medical staff verifications and ensures that the organization and staff are in accordance with organizational and industry standards. Additionally, Medical Staff Credentialing Director analyzes reports on applications and credential status to identify trends and improve the credentialing process. Presents files to the credentialing committee and may act as a liaison to state medical licensure boards regarding the status of license applications. Requires a bachelor's degree. May require Certified Provider Credentialing Specialist (CPCS). Typically reports to senior management. The Medical Staff Credentialing Director typically manages through subordinate managers and professionals in larger groups of moderate complexity. Provides input to strategic decisions that affect the functional area of responsibility. May give input into developing the budget. To be a Medical Staff Credentialing Director typically requires 3+ years of managerial experience. Capable of resolving escalated issues arising from operations and requiring coordination with other departments. (Copyright 2024 Salary.com)
-Accurately complete credentialing and reappointment applications to be sent to payers and facilities on behalf of providers.
-Monitoring workloads and ensuring completion of all assigned tasks in a timely manner – communicating with management on potential issues.
-Communicate the status of all applications to management and accurately maintain tracking spreadsheets.
-Set up and maintain electronic credentialing files for each practitioner while ensuring confidentiality and accuracy is priority.
-Request needed documentation from providers such as credentialing/recredentialing documents and information; performs primary source verification of credentialing information; reviews and analyzes the documentation for completeness and accuracy; follows up with physicians on application in a professional manner.
-Prepare professional communication both written and verbal with providers, contractors, and facilities.
-Must have the ability to make decisions in a timely fashion that are sound, accurate, and supported by the reasoning and inclusion of appropriate people.
-The successful candidate must be an enthusiastic team player who can work in a fast-paced environment, multi-task, prioritize tasks and handle obstacles with a poised demeanor and positive attitude. Investigate solutions to problems and determine the best course of action.
-Must be a self-motivated individual that communicates clearly and professionally with team members, physicians, vendors, facility credentialing representatives, and team leaders.
-3-5 years’ experience facility credentialing and or MSO required.
-Ability to demonstrate excellent oral, written, interpersonal, analytical, and negotiation skills.
-Ability to use various computer programs to include but not limited to excel, adobe and outlook.
-Ability to work autonomously with minimal direction.
-High School Diploma or equivalent required (Degree preferred)
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