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)
Our Mission, Vision, & Model of Care
At Union Community Care, our purpose is to spark equity through patient-led healthcare that welcomes and strengthens our communities by integrating body, mind, and heart.
We envision vibrant and healthy communities supported by inclusive healthcare that embraces each member’s unique culture, needs, and values, and emboldens them to make healthful choices that fuel their well-being and the well-being of others.
We believe in whole health. This means we address and heal disease but equally important, we work at the causes of the causes, the social ills that must be addressed to achieve true equity.
We listen, learn, and embrace the complex lives and unique strengths of our patients, and we work hard to break down all barriers to care. This means we look through a grassroots lens. We connect with our communities because we are our communities. Each of us is a neighbor, a friend, a family member, and together, we are a trusted community health center.
JOB SUMMARY
The Credentialing Specialist is responsible for all facets of the credentialing process for Professional and back up for Payer Credentialing. This position works closely with the Compliance, Billing, and Clinicians to ensure that all required documentation is obtained as requested. This position is also required to keep an accurate account of all licensees, certification etc., to make sure they are current.
SPECIFIC JOB DUTIES
CREDENTIALING - Professional
1. Participate in Interview of potential applicants to explain credentialing process
2. Credential Newly Hired Providers (see provider worksheet)
3. Advise Lancaster General of new Physicians to start Hospital Privileges process
4. Add Providers to Athena (see Athena notes) and encounter oversight
5. Add clinical staff to FTCA report
6. Prepare Monthly Board Report of Credentialed Providers
7. Re-credential (ongoing) 2 years from date of last credential for 100 clinical staff
8. Maintain Paycom Credentialing Form
HUMAN RESOURCES Professional
9. Complete employment verification requests.
10. Complete miscellaneous employee information requests such as pay history, position history, proof of training, respond to subpoena’s, etc.
11. Maintain employee paper files and records.
12. Assist with review of new policies and procedures.
13. Provide support to employees in various HR -related topics such as policies and procedures, assistance with resolving issues as they arrive.
Miscellaneous
14. Provide back up and/or assist Billing staff with Payer credentialing issues.
15. Communicate with Clinical staff ensuring all licensure and other professional documents are current
16. Maintenance of Clinical Staff Files paper and electronic
17. Maintenance of various provider listings
18. Liaison between UCC Providers and Lancaster General Medical Staff Office
POSITION REQUIREMENTS
Bachelor’s Degree or (2) years’ experience (certificates or schooling)
Credentialing experience and working with third party payers
Understanding of employment rules and regulations
English proficiency required
ESSENTIAL FUNCTIONS
In order to fulfill the requirements of this position, duties 1-30 are considered essential functions of the job.
ORGANIZATIONAL INVOLVEMENT
This position is required to participate in mandatory all staff meetings, team meetings and trainings.
Clear All
0 Medical Staff Credentialing Director jobs found in Lancaster, PA area