Medical Staff Credentialing Manager manages staff that process credentialing and recredentialing applications for health care providers. Oversees department operations to ensure compliance with all regulatory standards. Being a Medical Staff Credentialing Manager implements policies and procedures to ensure that applications are properly verified and accurately uploaded into an online credentialing database system. Analyzes reports on applications and credentialing status to identify trends and improve the credentialing process. Additionally, Medical Staff Credentialing Manager prepares files for 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 a director. The Medical Staff Credentialing Manager manages subordinate staff in the day-to-day performance of their jobs. True first level manager. Ensures that project/department milestones/goals are met and adhering to approved budgets. Has full authority for personnel actions. To be a Medical Staff Credentialing Manager typically requires 5 years experience in the related area as an individual contributor. 1 - 3 years supervisory experience may be required. Extensive knowledge of the function and department processes. (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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