Medical Staff Credentialing Supervisor oversees day-to-day activities of staff that process credentialing and recredentialing applications for health care providers. Implements department procedures to facilitate organized and up-to-date provider databases. Being a Medical Staff Credentialing Supervisor administers system for tracking license and certification expirations to ensure renewals are submitted in a timely fashion. Ensures that applications are properly verified and accurately uploaded into an online credentialing database system. Additionally, Medical Staff Credentialing Supervisor resolves complex questions regarding credentialing or provider database maintenance and best practices. Prepares reports on applications and credentialing status to identify trends and improve the credentialing process. May require a bachelor's degree. May require Certified Provider Credentialing Specialist (CPCS). Typically reports to a manager. The Medical Staff Credentialing Supervisor supervises a small group of para-professional staff in an organization characterized by highly transactional or repetitive processes. Contributes to the development of processes and procedures. To be a Medical Staff Credentialing Supervisor typically requires 3 years experience in the related area as an individual contributor. Thorough knowledge of functional area under supervision. (Copyright 2024 Salary.com)
Complete provider credentialing and re-credentialing application with contracted insurance companies and other accrediting entities.
Ensure all credentialing applications and forms are completed accurately, thoroughly and timely.
Monitor the status of each provider’s credentialing and re-credentialing application and forms. Follow-up with credentialing entities to ensure provider credentialing is completed timely.
Communicate status of provider credentialing to applicable practices and Administration.
Set up and maintain provider and practice information in online credentialing databases.
Contact and follow-up with providers to ensure all pertinent information is received to process credentialing, re-credentialing and accreditation to ensure timely filing and renewals.
Maintain credentialing files and documentation.
Maintain knowledge of credentialing guidelines and office participation and non-participation with insurance companies
Post and reconcile all payments received for clinic billing.
Prepare month-end payment reconciliation reports for clinics billing.
REQUIRED
PREFERRED
Education:
High school education or GED required
Associate’s Degree or higher preferred
Experience:
Three years billing, credentialing, denial management, etc.Insurance Credentialing experience preferred
Degrees, Licensure, and/or Certification:
Knowledge, Skills, and Abilities:
Detail Oriented, Confidentiality, Customer Service Oriented.
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