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)
POSITION SUMMARY:
Responsible for design, development, maintenance and operations of health system programs and outside contracted entities, for credentialing, medical education and medical staff services. Ensures compliance with NCQA and Joint Commission standards, Center for Medicare/Medicare (CMS), state and federal laws pertaining to credentialing and medical staff. Ensures compliance with Illinois State Medical Society (ISMS) Education and CEU accreditation. Primary liaison between the Chief Medical Officer, Medical Director of StaffCorp Inc, officers of the medical staff, health system leaders, health system legal team, local and regional medical staffs and health care practitioners regarding credentialing and medical staff services. Works directly with legal team and medical staff leaders pertaining to any legal issues involving credentialing actions, and/or disciplinary action of medical staff members or adverse credentialing decisions. Participates in continuous quality improvement activities as well as strategic health system initiatives. Develops and implements business and strategic initiatives ensuring the gold standard of credentialing is retained. Maintains ethics and confidentiality of position. Provides backup to the Chief Medical Officer on credentialing/privileging and other medical staffing issues, as necessary.
EDUCATION/TRAINING:
At least five years progressive management experience in a medical staff service or credentialing setting. Bachelor’s Degree in healthcare administration or related field preferred.
LICENSURE/CERTIFICATION:
Certification as a Provider Credentialing Specialist (CPCS) or Professional Medical Services Management (CPMSM) required. Must retain certification.
EXPERIENCE/SKILLS/ABILITIES:
Demonstrated leadership skills and management skills. Excellent communication, organization and critical decision-making skills required. Extensive working knowledge of health care delivery systems, Joint Commission and NCQA standards, regulatory compliance and state and federal laws relating to credentialing and medical staff services, strong knowledge and understanding of continuous quality improvement and peer review processes, risk management and utilization review processes pertaining to medical staff. Excellent interpersonal skills and ability to effectively interact with Board of Directors, health system legal team, physicians, administrators and all levels of staff within the organization and community. Ability to utilize complex database software, spreadsheets and databases. Successful completion of annual job specific competencies required.