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)
Job Summary
Handles the duties and operations of the medical staff office, ensuring compliance with standards set by the Joint Commission, NCQA, and other accrediting bodies related to medical staff services. Assists the Senior Medical Staff Credentialing Coordinators, who mainly handle the credentialing of medical staff and health professional affiliates.
Supports and incorporates the Frederick Health (FH) mission, vision, core values, and customer service philosophy into job performance. Adheres to the FH Compliance Program, including all regulatory requirements and FH Standards of Behavior.
Example of Essential Functions:
- Manages aspects of onboarding medical students and medical staff job shadowing.
- Researches, monitors, and updates non-staff provider licensure and OIG status.
- Works with other departments to verify non-staff providers are not exempt from the Office of Inspector General and possess active medical licenses to order prescribed outpatient tests.
- Works with Information Technology to update the medical provider dictionary with provider license expiration dates and office address changes.
- Ensures accurate medical staff information is available to departments, committees, and the public as necessary.
- Maintains a working knowledge of the Medical Staff Bylaws and medical staff policies to ensure compliance.
- Attends medical staff and other meetings as necessary. Prepares agendas, materials, and minutes of meetings as required.
- Monitors medical staff vaccine and mandatory CBL compliance.
- Assists with communication of provider deficiencies and suspensions.
- Assists with provider orientation and ID verification.
- Assists with reconciling invoices, statements, and check requests.
Required Knowledge, Skills, and Abilities:
- Interpersonal communication skills including adult learning methods and problem-solving; basic knowledge of medical terminology.
- Ability to work independently, prioritize projects, and meet deadlines.
- Strong organizational skills and the ability to manage multiple tasks. Ability to work professionally with a diverse population.
- Ability to maintain a high level of confidentiality.
- Ability to create, compose, and edit written materials.
Minimum Education, Training, and Experience Required:
- Proficiency in the use of software programs such as MS Word, Excel, and Outlook.