Medical Staff Credentialing Manager jobs in Trenton, NJ
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)
Recently Added Medical Staff Credentialing Manager jobs
Credentialing Manager
- Henry J Austin
-
Trenton, NJ
FULL_TIME
-
MAJOR FUNCTION
The Credentialing Manager is responsible for overseeing all aspects of credentialing applications and renewals for health care professionals. This position develops, implements, and monitors policies and procedures that support credentialing, re-credentialing, data management and delegated credentialing contract processes. The Credentialing Manager manages all credentialing functions including application management and primary source verification, ensures compliance with appropriate accrediting and regulatory agencies, supervises credentialing staff, and oversees credentialing workflows and/or services provided by third party vendors as appropriate. The Credentialing Manager will conduct all aspects of third-party credentialing for providers and facilities in accordance with CMS, FQHC (Federally Qualified Health Center) and third-party insurance standards.
ESSENTIAL FUNCTIONS
Manages credentialing processes for all LIPs, OLCPs and facilities in accordance with CMS accreditation standards, Federal and State laws, payer requirements, and all applicable external regulatory bodies.
Develops, implements and monitors policies and procedures to ensure timely and compliant external credentialing of all LIPs
Tracks and reports Key Performance Indicators (KPIs); participates in HJAHC’s Continuous Quality, Performance and Risk Management Plan (CQPRM) by committee attendance and QA/QI participation as appropriate.
Prepares and maintains credentialing files and reports for all LIPs and OLCPs including maintenance of credentialing software, facility rosters and spreadsheets to comply with group delegation requirements.
Processes and files applications with all third party payers according to each payer’s individual requirements, addresses/corrects discrepancies as requested by payers, and conducts all follow up steps until payer approval/completion is obtained.
Monitors and reports turnaround times for processing of credentials applications, with continued focus on delivery of a high quality product, with the greatest efficiency, in the least amount of time.
Files applicable provider practice change notifications and performs follow up duties until confirmed complete by payers.
Updates NPI records according to provider specifications.
Coordinates the management of the expirable process to ensure all clinical provider licenses and certificates remain current, ensuring appropriate notification prior to expiration. This includes appropriate updates to CAQH and payers.
Accepts and processes all requests from payers for credentialing information/updates/new contracts and products.
Answers questions, process requests from staff/providers related to credentialing information.
Address enrollment disconnects regarding facility and providers.
Prepares for and coordinates credentialing audits in compliance with payer credentialing contracts.
Assists with EHRS enrollment, tracking and filing.
Maintains quarterly payer specific rosters in accordance with CMS standards.
Assists in quarterly CAQH mass attestation.
Serves as liaison between Legacy and outside organizations and external customers.
Participates in the Performance Improvement Program.
Performs other duties and assumes other responsibilities as apparent and/or as assigned by Director of Human Resources. Duties, responsibilities and activities may change or new ones may be assigned at any time with or without notice.
Requirements
EDUCATION & EXPERIENCE:
Bachelor’s degree in business, human resource or related field required or six years of work experience in a related field in lieu of Bachelor’s degree.
At least five years’ experience in capacity as credentialing coordinator or credentialing specialist
FQHC experience preferred and/or experience in an ambulatory care setting.
Experience in payor credentialing preferred.
High energy and enthusiasm, positive, “can-do” attitude with a high degree of initiative
Must be able to work in a team environment and collaborative environment.
High attention to detail
Passion and commitment to community health
Demonstrated ability to use Microsoft Office applications, including Microsoft Word, Outlook,
Excel and PowerPoint
Have good working knowledge of guidelines and requirements of agencies and carriers.
FQHC credentialing experience is a plus.
Must have strong, clear communication skills.
Detailed oriented and organizational skills required.
KNOWLEDGE, SKILLS, ABILITIES AND OTHER EXPERIENCE
PHYSICAL & WORK REQUIREMENTS
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
This position requires manual dexterity sufficient to operate phones, computers, and other office equipment. The position requires the physical ability to kneel, bend, and perform light lifting. This person must have the ability to write and speak clearly using the English language to convey information and be able to hear at normal speaking levels both in person and over the telephone. Specific vision abilities required by this job include close vision, depth perception and the ability to adjust focus. The working conditions are good with little or no exposure to extremes in health, safety hazards and/or hazardous materials.
- 19 Days Ago
Credentialing Office Coordinator
- National Medical Reviews
-
Warminster, PA
FULL_TIME
- Role and Responsibilities: Credentialing: Facilitates all aspects of the peer reviewer credentialing process Builds, maintains and updates the peer reviewer panel Continuously recruits new peer review...
- 1 Month Ago
Medical Assistant, Clinical Support Staff
- Clare Medical of New Jersey
-
Mount Holly, NJ
FULL_TIME,PART_TIME
- Clare Medical of New JerseyWe are currently looking for a Medical Assistant to join our team.This is a Monday - Friday position with hours from 9:00am-5:30pm.This position requires daily travel to our...
- 9 Days Ago
Medical Account Manager
- Pacific Medical, Inc.
-
Trenton, NJ
FULL_TIME
- Established in 1987, Pacific Medical, Inc. is a distributor of durable medical equipment; specializing in orthopedic rehabilitation, arthroscopic surgery, sports medicine, prosthetics, and orthotics. ...
- 14 Days Ago
Field Service Staff Manager
- INNIO
-
Bristol, PA
PER_DIEM
- What if energy supply could be sustainable, affordable, and reliable at the same time? With its product brands Jenbacher and Waukesha and the digital platform myPlant, INNIO offers energy solutions fo...
- 21 Days Ago
Medical Manager
- Global Gastroenterology
-
Princeton, NJ
PART_TIME
- Hiring a part time medical manager, managing day to day operations of a traditional medical office and help with back office work Mondays, Thursdays, and Saturdays. Three days a week. 8 hours two days...
- 26 Days Ago
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0 Medical Staff Credentialing Manager jobs found in Trenton, NJ area
Quality Management Manager
- AmeriHealth Caritas
-
Trenton, NJ
- Job Brief Behavioral Health Quality Manager for PerformCare New Jersey. Master's level degree with added certification i...
- 4/24/2024 12:00:00 AM
Compliance Manager
- Language Services Associates, Inc.
-
Horsham, PA
- The Compliance, Contracting and Credentialing Manager is responsible for independently managing internal and external cl...
- 4/24/2024 12:00:00 AM
Systems Security Analyst / Cybersecurity Engineer / Mostly Remote
- Global Engineering & Technology, Inc.
-
North Philadelphia, PA
- This position requires a current DOE Q or DoD Top Secret security clearance. THIS IS A HYBRID-REMOTE POSITION. In its ma...
- 4/24/2024 12:00:00 AM
Cyber Security Engineer - PVH Corp
- PVH
-
Bridgewater, NJ
- Design Your Future at PVH Cyber Security Engineer - PVH Corp POSITION SUMMARY: The Cyber Security Engineer will be deepl...
- 4/22/2024 12:00:00 AM
Quality Management Manager
- AmeriHealth Caritas
-
Robbinsville, NJ
- Job Brief Behavioral Health Quality Manager for PerformCare New Jersey. Master's level degree with added certification i...
- 4/22/2024 12:00:00 AM
Medical Department & Credentialing Coordinator
- Esperanza Health Center
-
Philadelphia, PA
- Job Description Job Description POSITION SUMMARY: The full-time Medical Department Coordinator serves and advocates for ...
- 4/22/2024 12:00:00 AM
Medical Department & Credentialing Coordinator
- Esperanza Health Center
-
Philadelphia, PA
- Job Description Job Description POSITION SUMMARY: The full-time Medical Department Coordinator serves and advocates for ...
- 4/22/2024 12:00:00 AM
Program Supervisor - LCSW / LPC required
- Woods Services
-
Mount Holly, NJ
- Overview: Join our team and be a part of something extraordinary as we embark on a new journey with our new Crisis Diver...
- 4/20/2024 12:00:00 AM
About Trenton, New Jersey
According to the United States Census Bureau, the city had a total area of 8.155 square miles (21.122 km2), including 7.648 square miles (19.809 km2) of land and 0.507 square mile (1.313 km2) of water (6.21%).
Several bridges across the Delaware River – the Trenton–Morrisville Toll Bridge, Lower Trenton Bridge and Calhoun Street Bridge – connect Trenton to Morrisville, Pennsylvania, all of which are operated by the Delaware River Joint Toll Bridge Commission.
Trenton is located near the exact geographic center of the state, which is 5 miles (8.0 km) located southeast of Trenton. The city is so...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Medical Staff Credentialing Manager jobs
$104,534 to $134,799
Trenton, New Jersey area prices
were up 1.5% from a year ago
were up 1.5% from a year ago
What does a Medical Staff Credentialing Manager do?
Medical Staff Credentialing Manager in Wichita Falls, TX
With the growing numbers of employed practitioners, hospitals and health systems are looking at delegated credentialing to speed up the provider enrollment process and reduce accounts receivable write-offs and claim holds which delay or decrease the revenues received from payers for the services provided to patients.
December 04, 2019
Medical Staff Credentialing Manager in Memphis, TN
Medical staff services professionals deal with credentialing every day, but how do background checks complement this critical process.
February 18, 2020
Medical Staff Credentialing Manager in Lima, OH
Medical staff services is a self-governing body within a healthcare organization and is responsible for keeping with independent practitioners who serve healthcare facilities.
January 24, 2020