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)
Description
The Billing/Medical Administrative Assistant with Credentialing experience provides administrative support for the payer credentialing process (initial provider enrollment and re-enrollment). Work closely with appropriate staff to complete process. Collect all relevant information from the provider, provider’s malpractice insurer. Performs timely follow up for all outstanding provider enrollment applications and contracts. Understand Provider Enrollment requirements to ensure regulatory compliance, including but not limited to CAQH, NPPES, PECOS. Ensure that all provider files are maintained in an appropriate manner on an ongoing basis. Notify leadership of errors identified in a timely manner.
ESSENTIAL DUTIES AND RESPONSIBILITIES:
JOB DESCRIPTION CLAUSE
Describes the general nature and work being performed and are not to be construed as an exhaustive
list of responsibilities, duties and skills required of employees. This is subject to change at the discretion
of the employer.
Requirements
MINIMUM QUALIFICATION REQUIREMENTS:
High school diploma or equivalent with 2-3 years of related experience in Medical Billing and Credentialing.
Must be able to fluently speak, write and understand English
Self-starter with good organizational skills
Must possess excellent written and verbal communications skills
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