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)
SENTA is seeking a highly motivated and experienced Credentialing Manager to join our team. The Credentialing Manager will be responsible for managing the credentialing process for all healthcare providers within our organization, ensuring compliance with regulatory and accrediting agency requirements.
· Develops and maintains credentialing/re-credentialing processes to continually increase the efficiency and efficacy of credentialing for internal and external stakeholders.
· Reviews existing, develops new and maintains Credentialing Policies and Procedures, desktop policies and advises on the development of critical corporate guidelines and best practices.
· Supervises Credentialing Specialists, monitors their performance, identifies and addresses performance improvement opportunities.
· Manages credentialing submissions with expediency and accuracy with efficient internal and external communication throughout the process.
· Communicates and works to improve interdepartmental relationships with Credentialing, Recruitment, Human Resources, Revenue/Billing, Legal/Compliance, and other designated departments.
· Researches and analyzes issues, ensures appropriate documentation to identify outcomes and accurately interprets internal and external guidelines and policies.
· Develops, implements, and manages processes to create, update and maintain practitioner files for enrollment purposes and for ensuring accurate and timely completion of credentialing and practitioner enrollment.
· Prepare management and operational reports for internal and external customers.
· Maintains current Credentialing database up to date.
· Completes ongoing file review on an intermittent basis to identify objectives, error rates, timeliness and use data as an opportunity to counsel staff, as appropriate.
· Establishes and maintains production and quality metrics for Credentialing Specialist(s).
· Facilitates problem solving of operational and revenue cycle issues through collaboration with client health plans and internal stakeholders.
· Manages multiple projects simultaneously and under tight deadlines.
· Assists with resolution of contract and claim issues related to practitioner enrollment and identifies and communicates opportunities for process improvement.
· Responds to inquiries regarding practitioner credentialing and enrollment.
· Maintains confidentiality of all credentialing information in compliance with federal and state statutes, as well as SENTA policies.
· Perform other job duties as assigned.
Clear All
0 Medical Staff Credentialing Manager jobs found in Atlanta, GA area