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)
Primary Function/General Purpose of Position
The Credentialing Specialist facilitates Credentials Verification Organization (CVO) provider application and data collection, application processing and Primary Source Verification (PSV) for the organization. Supports the organization's on-boarding and off boarding processes. This role follows established standard operating procedures and market specific medical staff bylaws and demonstrates exceptional customer service, communication, reliability and commitment to quality.
Essential Job Functions
Follows a standardized comprehensive credentialing application and data collection, application processing, and primary source verification processes that comply with all applicable regulatory standards.
Executes credentialing application and data collection, application processing, primary source verification for all new applicants and applicants for re-credentialing. Assures applications are correct, complete, resolves discrepancies in compliance with all applicable regulatory standards.
Assures files and documents are ready for Medical Director review, including all Credential Committees and Medical Staff Office (MSO). Works with the credentialing auditors to correct any deficiencies.
Organizes and maintains provider data and files. Processes applications timely and ensures that quality benchmarks are met with regards to turnaround times, accuracy of information and other CVO and regulatory metrics.
Assures that provider database is maintained with new and updated accurate provider information.
Follows all regulatory requirements related to the primary source verification process for medical staff and managed care compliance.
Completes credentialing compliance check points to assure that files are ready for release.
Maintains awareness of The Joint Commission (TJC), National Committee for Quality Assurance (NCQA), Center for Medicare/Medicaid (CMS) and other regulatory compliance guidelines through the organization's CVO provided continuing education.
Demonstrates excellent professional communication skills while interacting with colleagues, customer relations and MSO representatives, and leadership to collect missing information or resolve issues.
Maintains a strong respect for privacy and confidentiality.
This document is not an exhaustive list of all responsibilities, skills, duties, requirements, or working conditions associated with the job. Employees may be required to perform other job-related duties as required by their supervisor, subject to reasonable accommodation.
Licensing/Certification
Certified Professional Medical Staff Management (CPMSM) or Certified Professional Credentials Specialist (CPCS) by National Association of Medical Staff Services (NAMSS) (preferred)
Education
High School or GED (required)
Bachelor's Degree in Business, Healthcare or other related field (preferred)
Master's Degree in Business, Healthcare or other related field (preferred)
Work Experience
1 year recent experience in medical staff services or CVO setting (preferred)
Training
Credentialstream Credentialing software (preferred)
Skills
Medical Staff Credentialing
Data Collection
Data Entry
Healthcare Policies
Confidentiality
Flexibility
Managing Multiple Priorities
Attention to Detail
Accuracy
Teamwork
Conflict resolution
Active listening
Relationship building
Self motivated
Accountability
Mistake Proofing
Autonomy
Managing Deadlines
Communication
Many of our opportunities reward* your hard work with:All applicants will receive consideration for employment without regard to race, color, national origin, religion, sex, sexual orientation, gender identity, age, genetic information, or protected veteran status, and will not be discriminated against on the basis of disability. If you'd like to view a copy of the affirmative action plan or policy statement for Mercy Health – Youngstown, Ohio or Bon Secours – Franklin, Virginia; Petersburg, Virginia; and Emporia, Virginia, which are Affirmative Action and Equal Opportunity Employers, please email recruitment@mercy.com. If you are an individual with a disability and would like to request a reasonable accommodation as part of the employment selection process, please contact The Talent Acquisition Team at recruitment@mercy.com
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