Medical Staff Credentialing Manager jobs in Florida

Medical Staff Credentialing Manager manages staff that process credentialing and recredentialing applications for medical providers. Implements policies and procedures to ensure that applications are properly verified and accurately uploaded into an online credentialing database system. Being a Medical Staff Credentialing Manager presents files to the credentialing committee and may act as a liaison to state medical licensure boards regarding the status of license applications. Analyzes and prepares reports on trends in application status. Additionally, Medical Staff Credentialing Manager typically requires a bachelor's degree. 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)

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Credentialing Manager
  • Chen Medical
  • Miami, FL FULL_TIME
  • Company DescriptionChenMed is transforming healthcare for seniors. We provide big answers to big problems in health care delivery.ChenMed is a full-risk primary care market leader with an innovative philosophy, unique physician culture and end-to-end customized technology. These things allow us to provide world-class primary care and coordinated care to the most vulnerable population – moderate- to low-income seniors who have complex chronic diseases.Through our innovative operating model, physician-led culture and empowering technology, we are able to drive key quality and cost outcomes that create value for patients, physicians and the overall health system.Our model allows us to practice medicine the way it should be practiced. By recruiting focused physicians and reducing their doctor-to-patient ratios, we increase patients’ “face time” during each monthly appointment and help foster stronger doctor-patient relationships. Our model also drives and enhances compliance with treatment plans.As a result of our efforts, our patients realize lower hospital admissions. Their overwhelming response to our approach is reflected in our aggressive, organic growth and net promoter scores in the low to mid 90s, which is unheard of in any industry. Read more about our results and the value of the ChenMed model.As a company, we are making a difference in the lives of seniors and the health care system overall.Job DescriptionThe Credentialing Manager is responsible for managing a team of credentialing professionals and is accountable for systems and processes that ensure compliance with organizational credentialing policies and procedures, and compliance with the credentialing requirements of our health plan partners, and related regulatory and accrediting agency requirements. This individual will oversee the initial and ongoing application process for all clinicians and is responsible for: maintaining the organization’s credentialing databases and online systems, maintaining up-to-date credential files, and managing all health plan enrollments and reappointments, as well as, managing all initial and ongoing applications for medical staff privileges at ChenMed designated facilities. Primary Duties and Responsibilities:• Ensure compliance with ChenMed’s credentialing and recredentialing policies and procedures, and compliance with state, federal, accreditation and health plan credentialing requirements.• Collaborate with leadership on policy development and standardization of criteria / processes across the organization.• Maintain and ensure up-to-date credentialing files.• Responsible for the accuracy and integrity of credentialing files, credentialing database and reporting systems.• Monitors external credential databases, including CAQH, PECOS and other regulatory agencies, to ensure data is updated and ready for quick retrieval and use by interested parties.• Ensure credentialing files are complete before presentation to Credentialing Committee.• Provide consultation to Credentialing Committee / leadership on issues related to consideration of clinician credentials and reappointments.• Oversee compliance with health plan requirements related to delegated credentialing agreements and credentialing file audits.• Oversee processes and reviews (including ensuring resolution) all reports related to adverse actions such as sanctions, licensure actions or limitations, and credentialing-related complaints.• Interview, hire and train new staff on credentialing and recredentialing policies and procedures; also provides ongoing training as needed regarding new guidelines or updated processes / policies.• Daily monitoring of employee’s workload and various credentialing work streams (e.g. onboarding, credentialing, pharmacy, medical staff privileging, Medicare/Medicaid enrollments, Credentialing Committee meetings, health plan enrollments, etc.). • Play an important role in making decisions regarding employee’s performance issues such as the need for disciplinary counseling, performance documentation and/or termination.• Conducts periodic audits of credentialing files and staff work-product.• Oversees initial applications and reappointments for Medicare / Medicaid enrollment, hospitals, surgical centers and managed care entities for assigned divisions. • Develops and provides regular reports and presentations concerning the operation and progress of the credentialing functions, including activity related to approvals, denials and / or appeals.Other responsibilities may include:• Monitor renewals of licensure and other documents subject to expiration, and ensures updates are forwarded to facilities and healthcare partners as renewals are received.• Oversee and coordinate health plan office site visits.• Work with leadership to identify and implement best practices related to credentialing.• Responds to facilities and health plan inquiries, interfaces with internal staff and external customers on day-to-day credentialing issues.• Collaborates with leadership on submitting and maintaining up-to-date health plan rosters.• Responsible for management and supervision of credentialing staff / team.• Upon request of supervisor, attends meetings with payer representatives to address outstanding issues.• Respond to internal / external request for credentialing and licensing status.• Develop reports to present to the leadership staff as requested.• Other activities as outlined in the credentialing and recredentialing policies and procedures.• Other duties as assigned and modified at manager’s discretion.Qualifications• Bachelor’s degree in business administration or health care related field required. • Strong understanding and use of web-based credentialing applications. Experience with MDStaff preferred.• Working knowledge of NCQA, AAAHC, JCAHO, AOA, URAC and other applicable accreditation and regulatory standards• Database management skills including querying, reporting, and document generation.• Five to Seven (5-7) years of Credentialing experience required. • Two (2) year experience in a Lead/Management capacity required.• Certified Provider Medical Services Management (CPMSM) / Certified Provider Credentialing Specialist (CPCS) Certification preferred (Required to obtain certification within 6-12 months of hire).Additional Information• Advanced knowledge of Microsoft Office Software (Excel, Access, and Word), database administration and scanning applications.• Strong organizational, verbal and written communication skills.• Ability to work effectively with staff, physicians and external customers.• Ability to work independently with limited supervision.• Multi-tasking and knowing how to set priorities. • Fluent in English. EDUCATION / SPECIALIZED KNOWLEDGE REQUIREMENTS:
  • 15 Days Ago

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Credentialing Coordinator - Medical Staff Office - FT - Day
  • Stormont Vail Health
  • Remote, FL FULL_TIME
  • Schedule : Full time - 36 hours / week or greater Shift : First Shift (Days - Less than 12 hours per shift) (United States of America) Weekly Work Schedule : 8 am - 4 : 30 pm M-F Job Information Exemp...
  • 1 Month Ago

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Medical Credentialing Specialist
  • Orlando Family Medical
  • Kissimmee, FL FULL_TIME
  • Orlando Family Medical is looking for a person with acknowledgement in credentialing physicians. Must have minimum 2 years credentialing experience. Must have knowledge of credentialing, human resourc...
  • 1 Day Ago

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Credentialing Specialist
  • ABC Home Medical Supply, Inc.
  • Port Saint Lucie, FL FULL_TIME
  • The Credentialing Specialist is responsible for assisting in all aspects of the licensing and credentialing of the Company. The Specialist will process applications on behalf of the Company in order t...
  • 23 Days Ago

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Credentialing Specialist
  • Athena Medical Management Group LLC
  • Springs, FL FULL_TIME
  • Athena Medical Management Group, LLC is looking for a detail- oriented individual to work in a team-centric medical staff services department as licensing specialist. Specific Duties and Responsibilit...
  • 10 Days Ago

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Credentialing Specialist
  • Orthopaedic Medical Group of Tampa Bay
  • Lithia, FL FULL_TIME
  • Orthopaedic Medical Group of Tampa Bay is a fast-paced and well-established orthopaedic practice with 9 locations. The Credentialling Specialist is responsible for our credentialling process of all ph...
  • 16 Days Ago

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Credentialing Manager
  • DOCTORS HEALTHCARE PLANS, INC.
  • Miami, FL
  • Scope of Position: Manages staff that process credentialing and recredentialing applications for medical providers and p...
  • 3/28/2024 12:00:00 AM

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Provider Credentialing Manager
  • 10X Health System
  • North Miami Beach, FL
  • POSITION SUMMARY As a Provider Credentialing Manager, you will be responsible for managing the onboarding process for he...
  • 3/28/2024 12:00:00 AM

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Ticket Fulfillment & Credential Manager
  • Churchill Downs Racetrack
  • Louisville, KY
  • POSITION SUMMARY:Oversee the day to day operations, ticket management, and primary point of contact role for ticket fulf...
  • 3/28/2024 12:00:00 AM

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City Manager - Manassas, Virginia
  • Baker Tilly
  • Manassas, VA
  • Salary: $210,700.00 - $273,000.00 Annually Location : Manassas, VA Job Type: Full-Time Job Number: 00197 Job Classificat...
  • 3/28/2024 12:00:00 AM

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Credentialing Manager
  • AMPP: Association for Materials Protection and Performance
  • Houston, TX
  • Job Description Job Description SUMMARY Oversight and responsibility for the administration, operations and customer exp...
  • 3/27/2024 12:00:00 AM

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Provider Credentialing Manager
  • 10X Health System
  • Aventura, FL
  • POSITION SUMMARY As a Provider Credentialing Manager, you will be responsible for managing the onboarding process for he...
  • 3/26/2024 12:00:00 AM

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City Manager - Hutchinson, Kansas
  • Baker Tilly
  • Hutchinson, KS
  • Salary: $165,000.00 - $190,000.00 Annually Location : Hutchinson, KS Job Type: Full-Time Job Number: 00150 Job Classific...
  • 3/25/2024 12:00:00 AM

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Principal Consultant GP, OSPF and Switching Cisco, Network Segmentation and Isolation/NYC, NY 1 Year
  • Suncap Technology, Inc.
  • New York, NY
  • Location: NYC, NY US Citizen Required Experience: BGP, OSPF and Switching Cisco Network Segmentation and Isolation Virtu...
  • 3/24/2024 12:00:00 AM

Florida (/ˈflɒrɪdə/ (listen); Spanish for "land of flowers") is the southernmost contiguous state in the United States. The state is bordered to the west by the Gulf of Mexico, to the northwest by Alabama, to the north by Georgia, to the east by the Atlantic Ocean, and to the south by the Straits of Florida. Florida is the 22nd-most extensive (65,755 sq mi or 170,300 km2), the 3rd-most populous (21,312,211 inhabitants), and the 8th-most densely populated (384.3/sq mi or 148.4/km2) of the U.S. states. Jacksonville is the most populous municipality in the state and the largest city by area in th...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Medical Staff Credentialing Manager jobs
$85,622 to $117,692

Medical Staff Credentialing Manager in Cedar Rapids, IA
Medical Staff Services Coordinator - Credentialing - Full-Time (40hrs/wk), Days - Corporate Services - Glendale, WI.
January 14, 2020
Medical Staff Credentialing Manager in Tampa, FL
Patient safety is the name of the game in credentialing.
January 25, 2020
Medical Staff Credentialing Manager in Nassau, NY
There are several reasons why a commercial payer, such as a managed care organization or health plan, may consider delegating all or part of its credentialing activities to qualified business partners such as IPAs, PHOs, CVOs, medical societies, even other health plans.
December 17, 2019