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)
Your time at work should be fulfilling. Rewarding. Inspiring. That’s what you’ll find when you join one of our non-profit CHI facilities across the nation. You’ll find challenging, rewarding work every day alongside people who have as much compassion as you. Join us and together we’ll create healthier, stronger communities.
Working at the physical location at:
With you in mind, we offer the following benefits to support your work/life balance:
CHI Health St. Francis was established in Grand Island Neb. in 1887. Today our hospital is a regional referral center with more than 100 physicians and more than 1100 employees working together to build a healthier community. Our goal is to provide patients with high-quality medical care close to home where they can be supported by their family friends and community.
Responsibility for credentialing and re-credentialing of Physicians, Advanced Practice Clinicians, Ancillary Providers and Facilities. Ensures optimum utilization of the managed care credentialing process through proactive coordination and tracking of all information in the credentialing files of all providers in CHI Health Partners as well as being responsible and accountable for maintenance of credentialing related information. Presents with positive and cooperative image with internal and external customers and contacts.
ESSENTIAL KEY JOB RESPONSIBILITIES
1. Manages credentialing and re-credentialing process for CHI Health Partners (CHP).
2. Coordinates provider CHP packets and receipt of credentialing files from Med Staff Services.
3. Develop, update and coordinate the implementation of Credentialing policies and procedures for approval by the Clinical Integrated Network (CIN) and final approval CIN Board, as needed.
4. Ensures compliance and adherence to NCQA standards of function and responsibility relates to credentialing for CHP.
5. Works with provider offices and facilities to attain correct information.
6. Responsible for preforming verification by query to the National Practitioner Data Bank (NPDB),
Office of Inspector General (OIG), System for Award Management (SAM), Medicare Opt Out and State
Exclusions and Sanctions for Nebraska and Iowa.
7. Completes process of credentialing new providers by sending the welcome letter and contract. Runs new provider report to send to all managed care payer, recredentialed providers receive a letter
showing the file is up to date. This all happens after they have been approved by the CIN Council and Board.
8. Coordinates and prepares for payer audits of CHP credentialing files for those networks which
Delegate credentialing to CHP.
Required:
High School diploma or equivalent required Associates degree in business or related field or equivalent. Combination of academic and/or professional experience required. Candidates without an Associate’s Degree must possess 1-3 years related experience.
Preferred Qualifications:
Excellent research, verification skills and attention to detail. Ability to work with providers, office staff and hospital administrators. Proficient in word processing and excel spreadsheets. This individual must maintain strict confidentially, communicate effectively, and work independently
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