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)
Complete provider credentialing and re-credentialing application with contracted insurance companies and other accrediting entities.
Ensure all credentialing applications and forms are completed accurately, thoroughly and timely.
Monitor the status of each provider’s credentialing and re-credentialing application and forms. Follow-up with credentialing entities to ensure provider credentialing is completed timely.
Communicate status of provider credentialing to applicable practices and Administration.
Set up and maintain provider and practice information in online credentialing databases.
Contact and follow-up with providers to ensure all pertinent information is received to process credentialing, re-credentialing and accreditation to ensure timely filing and renewals.
Maintain credentialing files and documentation.
Maintain knowledge of credentialing guidelines and office participation and non-participation with insurance companies
Post and reconcile all payments received for clinic billing.
Prepare month-end payment reconciliation reports for clinics billing.
REQUIRED
PREFERRED
Education:
High school education or GED required
Associate’s Degree or higher preferred
Experience:
Three years billing, credentialing, denial management, etc.Insurance Credentialing experience preferred
Degrees, Licensure, and/or Certification:
Knowledge, Skills, and Abilities:
Detail Oriented, Confidentiality, Customer Service Oriented.
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