Manager Credentialing

General Summary of Position Responsible for overseeing the day-to-day management of either the initial credentialing or reappointment processes for medical providers within MedStar Health. This role ensures that all credentialing activities are performed in accordance with regulatory requirements, accreditation standards, and organizational policies. Leads a team of credentialing analysts, ensure timely and accurate processing of applications, and support initiatives to improve operational efficiency and quality. Primary Duties and Responsibilities Supervises and leads a team of credentialing specialists focused on either initial credentialing or reappointment processes; provides guidance, training, and professional development opportunities to team members to enhance their skills and performance. Monitors the team performance, sets goals, and ensures accountability for achieving department objectives. Oversees the processing of initial or reappointment credentialing applications, ensuring that all required documentation is collected, verified, and reviewed according to established procedures. Ensures compliance with all relevant regulatory and accreditation standards, including those set by The Joint Commission, NCQA, CMS, and state-specific requirements. Coordinates with medical staff offices, department heads, and other stakeholders to facilitate the credentialing and privileging process. Identifies opportunities to streamline credentialing workflows and enhance operational efficiency, including the use of technology and automation. Implements and maintains quality assurance measures to ensure accuracy and completeness of credentialing files. Participates in continuous improvement initiatives to reduce turnaround times and improve customer satisfaction. Ensures that all credentialing activities comply with internal policies and external regulations, mitigating risks associated with non-compliance; conduct regular audits of credentialing files and processes to identify areas for improvement and implement corrective actions as needed. Maintains up-to-date knowledge of regulatory changes and industry best practices to ensure ongoing compliance. Serves as a key point of contact for internal stakeholders, including medical staff leadership, department heads, and other relevant parties. Collaborates with the Senior Director and other managers within the Central Verification Office to ensure consistency and alignment of credentialing processes across the system. Responds to inquiries and resolve issues related to the credentialing process in a timely and professional manner. Utilizes credentialing software and databases to manage provider information and track the status of applications. Generates regular reports on credentialing activities, including metrics related to processing times, compliance, and team performance; provide insights and recommendations to the Senior Director based on data analysis and trends. Minimum Qualifications Education Bachelor's degree In Healthcare Administration, Business Administration, or a related field. required One year of relevant education may be substituted for one year of required work experience. Experience 1-2 years Previous supervisory or management experience within healthcare credentialing or medical staff services preferred and 5-7 years In a Central Verification Office (CVO) or similar centralized credentialing and verification environment required One year of relevant professional-level work experience may be substituted for one year of required education. Licenses and Certifications Certified Provider Credentialing Specialist (CPCS) Upon Hire preferred and Certified Medical Professional Services Management (CPMSM) Upon Hire preferred Knowledge, Skills, and Abilities Strong leadership and team management skills, with the ability to motivate and develop -depth knowledge of credentialing and privileging processes, including regulatory and accreditation requirements.Excellent communication and interpersonal skills, with a focus on collaboration and customer service.Proficiency in credentialing software, data management, and reporting tools.Strong organizational and problem-solving abilities, with attention to detail. This position has a hiring range of $70,428 - $131,310

Created: 2024-11-05