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)
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.