Credentialing Manager jobs in Wilmington, DE

Kent Campus Hospital

STATUS:Full Time 72 Hours

SHIFT:  Days

GENERAL SUMMARY:

Summary:

Within the Bayhealth system, evaluates, analyzes and coordinates all aspects of initial credentialing processes for practitioners applying to practice within the Bayhealth system and clinical entities. Provides integral support to healthcare operations by enabling timely onboarding of medical staff practitioners.

ESSENTIAL FUNCTIONS & ACCOUNTABILITIES:

1. Reviews and screens all initial credentialing applications for completeness, accuracy and compliance with federal, state, local and Bayhealth regulations, guidelines, policies and standards.
2. Conducts primary source verification, collects and validates documents to ensure accuracy of all credentialing elements; assesses completeness of information and qualifications relevant to credentialing standards and Bayhealth criteria.
3. Identifies, analyzes and resolves extraordinary information, discrepancies, time gaps and other idiosyncrasies that could adversely impact ability to credential practitioners; discovers and conveys problems to the Department Chair, Credentials Chair, Credentialing Manager and others as necessary for sound decision making in accordance with Medical Staff Bylaws, credentialing policies and procedures, federal, state and local regulations.
4. Prepares, issues, tracks and follows-up on appropriate verifications for efficient, high-volume processing of individual applications in accordance with applicable credentialing standards, established procedural guidelines and strict timelines.
5. Processes temporary privileges, resignations, leaves of absence, modification of privileges and suspensions.
6. Participates in the development and implementation of process improvements for the system-wide credentialing process.
7. Communicates clearly with practitioners, their liaisons, medical staff leadership and Administration, as needed to provide timely responses upon request of day-to-day credentialing and privileging issues as they arise.
8. Assists with development, revisions, and updates to delineation of privileges.
9. Shares responsibility for the agenda, minutes and administrative support for the Credentials Committee, Medical Executive Committees, and PI Committee of the Board
10. Attends the Credentials Committee, Medical Executive Committee and PI Committee of the Board meetings.
11. Participates in Corrective Action and Fair Hearing proceeding as needed.
12. Assists in the development and maintenance of data in MD-Staff, and Practitioner credentials files.
13. Maintains a current knowledge of the National Practitioner Data Bank guidelines and NPDB Continuous Query enrollments. Maintains a current knowledge of the Medical Staff Bylaws and Rules and Regulations.
14. Prepares required reports for physician monitoring / Medicare Attestation audits. Prepares medical staff reports as necessary/requested.
15. Participates in committees/meetings as necessary (i.e., BHMG Onboarding, Service Development, new contracted groups).
16. Shares responsibility for supervision of Medical Staff Assistants.
17. Assists members of the medical staff as needed.
18. Maintains professional growth and development through seminars, webinars and professional affiliations to keep abreast of latest developments to enhance understanding of various guidelines and legislation of the health care industry.
19. All other duties as assigned, within the scope and range of job responsibilities.

REQUIRED MINIMUM EDUCATION AND CREDENTIAL:

• Education High School Diploma or GED
  
  
  
• Credential None Required
  
  

EXPERIENCE:

Required: At least three (3) years experience in an office setting requiring well developed spreadsheet and word processing skills.

Preferred: At least one year in a medical staff credentialing position

PREFERRED EDUCATION AND CREDENTIAL:

• Education Associate Degree
  
  Or equivalent training with at least three years experience in a medical office setting.
  
• Credential Certified Provider Credentialing Specialist
  
  

To view a full list of all open position at Bayhealth, please visit: 

https://apply.bayhealth.org/join/