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)
Position Summary
Provides general administrative and clerical tasks within the department and provides backup administrative support, if needed; maintains critical and confidential credentialing, privileging, provider enrollment and peer review information; executive correspondence; ongoing- professional, performance evaluations (OPPE); and focused professional performance evaluations (FPPE). Recognize and maturely handle a variety of situations, often of a confidential or urgent nature.
Primary Position Responsibilities
1. Administrative Support - Dictate and transcribe Committee meetings, e.g. Credentialiing Committee, Medical Executive Committee, General Medical Staff and other committees assigned by the Manager. Assistance with events, e.g., Doctors Day delivery of appreciation gifts.
2. Application Processing - Follow application processes, e.g. primary source verification, audit application for completeness, notify practitioner of any incomplete or oustanding documents, self file audits when applicaiton is completed.
3. Provider Enrollment - Follow processes for PECOS, CAQH, Medicaid, and NPPES processes.
4. Customer Service
5. Data Entry - Uploading documents, linking documents, etc
7. Unassigned Call Schedule -Update the unassigned On-Call Schedule as needed. This includes auditing the on-call schedule on a weekly basis.
Work Contact Group (Internal/External)
Medical Staff, Advanced Practice Professionals, staff at all levels of the organization, external organizations and their representatives, and the general public.
Reporting Relationships
Reports to (position):
Manager, Medical Staff Services
Supervises (position(s):
None
Qualifications
Minimum Education:
Required:
High School Graduate or Equivalent
Preferred:
Certificate and/or Advanced Specialized or Technical Training in Medical Staff Services or Associate Degree
Minimum Years of Experience (Amount, Type and Variation):
Required:
One (1) year of credentialing or provider enrollment experience
Preferred:
Two (2) years of credentialing or provider enrollment experience.
License, Registry or Certification:
Required:
None
Preferred:
Certification by NAMSS as a Certified Provider Credentials Specialist (CPCS) or the ability to become certified within the time periods established by NAMSS from date of hire.
Knowledge, Skills and/or Abilities:
Required:
Ability to prioritize, work in a fast-paced environment; meet ongoing schedules and deadlines, detailed oriented, organized, good judment, self motivated, ability to multi task and work independently. Proficient in the use of multiple computer software programs
Preferred:
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