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)
Credentialing Supervisor
The Credentialing Supervisor will report to the credentialing supervisor and/or office supervisor.
Job Overview: This position entails communicating directly with the providers in person, via email and/or via phone, as well as hospitals and/or insurance companies. You will be responsible for enrolling and maintaining the participation status of the providers with hospitals and/or insurance companies, as well as verifying demographic information and providing up to date licensures to ensure the most accurate information is on file for the providers.
Responsibilities and Duties:
· Communicate with provider to obtain all documents necessary to credential.
· Contact insurances and/or hospitals to initiate the application process.
· Complete and submit hospital and/or insurance applications with all necessary signatures and applicable documents.
· Communicate with the insurances and/or hospitals to follow up on the status of applications.
· Complete and submit Electronic Remittance Advice and Electronic Funds Transfer forms.
· Transfer letters in notes, scan, and file
· Input detailed notes of daily activity in spreadsheet.
· Verify, complete & submit provider demographic forms to insurances.
· Send out updated licensures upon renewal to insurances and/or hospitals.
· Maintain email volume, work in a timely manner.
· Answer phone, attend call and/or route as needed.
· Review and approve insurance contracts.
· Manage fee Schedule Negotiations.
· Manage CAQH updates and attestation.
· Track and ensure all credentialing for all employees on site and remote.
· Manage Credentialing Software.
· Assist employees with questions or concerns.
· Enforce office rules and regulations.
· Provider disciplinary action when required.
· Set new credentialing guidelines.
· Assist employees with daily work duties.
· Resolve any issue at hand by using resources available.
Qualifications:
Skills:
· Microsoft word, Excel, Outlook
Job Type: Full-time
Schedule:
Ability to Relocate:
Work Location: In person
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