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)
Job Summary
Handles the duties and operations of the medical staff office, ensuring compliance with standards set by the Joint Commission, NCQA, and other accrediting bodies related to medical staff services. Assists the Senior Medical Staff Credentialing Coordinators, who mainly handle the credentialing of medical staff and health professional affiliates.
Supports and incorporates the Frederick Health (FH) mission, vision, core values, and customer service philosophy into job performance. Adheres to the FH Compliance Program, including all regulatory requirements and FH Standards of Behavior.
Example of Essential Functions:
- Manages aspects of onboarding medical students and medical staff job shadowing.
- Researches, monitors, and updates non-staff provider licensure and OIG status.
- Works with other departments to verify non-staff providers are not exempt from the Office of Inspector General and possess active medical licenses to order prescribed outpatient tests.
- Works with Information Technology to update the medical provider dictionary with provider license expiration dates and office address changes.
- Ensures accurate medical staff information is available to departments, committees, and the public as necessary.
- Maintains a working knowledge of the Medical Staff Bylaws and medical staff policies to ensure compliance.
- Attends medical staff and other meetings as necessary. Prepares agendas, materials, and minutes of meetings as required.
- Monitors medical staff vaccine and mandatory CBL compliance.
- Assists with communication of provider deficiencies and suspensions.
- Assists with provider orientation and ID verification.
- Assists with reconciling invoices, statements, and check requests.
Required Knowledge, Skills, and Abilities:
- Interpersonal communication skills including adult learning methods and problem-solving; basic knowledge of medical terminology.
- Ability to work independently, prioritize projects, and meet deadlines.
- Strong organizational skills and the ability to manage multiple tasks. Ability to work professionally with a diverse population.
- Ability to maintain a high level of confidentiality.
- Ability to create, compose, and edit written materials.
Minimum Education, Training, and Experience Required:
- Proficiency in the use of software programs such as MS Word, Excel, and Outlook.
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