Medical Staffing Credentialing Manager

Job Description

Job Description

Description:

Under the general direction of the Executive Director of HIM and Compliance, the Medical Staff Credentialing Manager will coordinate and manage administrative activities and processes of the Medical Staff and Allied Health credentialing in accordance with TJC, federal, state, and local guidelines, organizational and departmental policies and procedures. Also perform Provider enrollment for pay sources. Communicates with medical staff, other departments, and outside agencies while maintaining confidentiality. Monitoring and tracking Peer Reviews. (OPPE/FPPE). Coordinates and documents monthly committee meetings. Position requires self-motivation, creativity, and capabilities to function in a semi-autonomous role within a fast pace and dynamic environment.

Standard of Performance

1. Maintains current, accurate demographic and credentials data on Medical Staff.
2. Input and verify medical staff licenses and insurance information into Simplr PRIVPlus computer software.
3. Monitors monthly that all licenses and certifications remain current at 100% level.
4. Facilitate monthly Credentialing Committee meetings: including agenda planning, coordinating meals and taking minutes.
5. Monitor Joint Commission medical staff standards to ensure compliance.
6. Input and manages Simplr Peer Review software to meet requirements as per Joint Commission standards on FPPE and OPPE.
7. Completes timely Provider Enrollment to assure all Physicians and Mid-Levels are able to bill for payment of services rendered with current Georgia licensed provider within 45-60 days and Provider applying for Georgia license of 90-120 days.
8. Performs the initial credential and biannual re-credential process within the by-laws and policy time frame (Medical Providers: Hospital, Care Center, Practices).
9. Assists Medical Staff with by-law education and reviews by-laws annually for needed revisions.
10. Coordinates and ensures completion of Medical Providers, background checks and verifications, primary source verifications, peer references, hospital affiliations, NPDB/OIG sanction monitoring, board certification/CME/Flu/PPD/COI Management, .
11. Ensures Charts and transfer reviews are completed.
12. Provides orientation to new Physicians to the health system following the orientation checklist.
13. Leads and coordinates special projects and activities, i.e. 501 (c) (3) hospital conversion, 340B (annual renewals and track contractor agreements), Electronic Medical Staff Records, and Electronic Medical Staff Application Process via Sympir.
14. Sends approval letters out to all approved providers after the credentials meeting and maintains copy in each provider file.
15. Performs the initial credential and biannual re-credential process within the by-laws and policy time frame.
16. Follow up on queries sent out by the Medical Staff office to assure completion within timeframe of project.
17. Coordinates the completion of all Facility Business Licenses (initial and renewals).
18. Coordinates CLIA Licenses initial and renewals.
19. Coordinates hospital pharmacy and retail.

Minimum Level of Education: Education level equivalent to completion of two years of college or technical school. This position requires strong mathematical and analytical skills, and the ability to formulate computerized reports.

Formal Training: Must have a good working knowledge of Excel Level II, Word Level II, and be proficient in PowerPoint..

Licensure, Certification, Registration: None Required

Work Experience: Three to five years related work experience.