Overview
This position is a customer service oriented position that will direct the daily activities of a high volume credentialing department. Provides direct interaction with hospital medical staff services and other departments requiring specific provider related information. In addition this position will maintain positive relationships with our providers and facilities, ensuring that information is provided timely and problem resolution is a seamless process. This position will ensure the integrity of all information provided to facilities and or Government agencies while maintaining the utmost confidentiality.
Job Highlights
ESSENTIAL DUTIES AND RESPONSIBILITIES (include but not limited to):
CREDENTIALING:
- Supervise the daily activities of the credentialing team.
- Effectively communicate expectations to employees.
- Foster and encourage a fair and positive work environment.
- Responsible for providing adequate training, guidance, support and structure to credentialing employees.
- Responsible for monitoring department productivity and meeting work standards and hold employees accountable when standards are not being met.
- Support Regional Credentialing Manager to meet departmental and organizational goals.
- Establish and maintain an effective professional working relationships with providers, division managers, USAP senior management team and medical staff service departments.
- Identify, support and implement departmental improvements and efficiencies.
- Ensure timely and accurate submission of all data to hospitals and facilities.
- Analyze, research and respond to escalations that have occurred during credentialing process. Involve Regional Manager if unable to resolve at supervisor level.
- If applicable, review and present files to the QI Committee on a monthly basis for new credentialing or re-credentialing evaluations.
- Participate in the yearly malpractice insurance renewal process working closely with the Credentialing leadership team.
- Maintain minimal privilege count predetermined for this position level.
- Foster a culture of trust and understanding to achieve a positive working environment.
- Assist auditing team files for quality metrics
- Assist team members and manager with department projects
- Ensure that any issues regarding state medical license, Federal Drug Enforcement Administration (DEA), or other pertinent agency data are resolved timely and with the utmost confidentiality.
- Monitor and notify providers of upcoming expriable, including expiring privileges, licensures, board certifications, MOC requirements and all other state and national required documents necessary for the practitioner to legally and ethically perform under their scope of practice.
- Maintain and update the credentialing database and medical staff services as provider information and credentials change or renew.
- Maintain and update continuing medical education credits and other training requirements.
- Establish and maintain professional working relationships with providers and medical staff service departments.
- Provide weekly status updates to providers and leadership.
- Demonstrate exemplary customer service to our providers and facilities.
- Meet targeted credentialing deadlines and start dates.
- Ensure all departmental policies and procedures are documented, maintained and followed on an on-going basis.
- Responsible for maintaining data integrity and work processes of the credentialing system. Performs other duties as assigned.
Qualifications
REPORTING TO THIS POSITION: Credentialing Staff
JOB REQUIREMENTS (Knowledge, Skills and Abilities):
- Direct management experience related to maintaining appointments and reappointments for a large provider base
- Must be able to select, develop, effectively manage and motivate staff
- Knowledgeable of NCQA and/or JCAHO Accreditation standard
- Knowledgeable in Federal and State Regulation on Confidentiality and Peer Review guidelines.
- Skilled in computer applications including MS Word, MS Excel, database administration and online hospital application portals
- Skilled in verbal, written and email communications
- Maintain equality among all peers
- Demonstrate ability to work cooperatively with employees, peers, senior leadership, physicians, and external customers.
- Ability to prioritize and organize work and projects to ensure focus on high impact/value added activities and meet deadlines.
- Ability to effectively work well under pressure in a fast paced environment.
- Ability to recognize and effectively respond to urgent situations.
- Act decisively, making good ethical decisions based on analysis, experience and judgement in a timely manner.
- Must possess a professional pleasant disposition and tolerance for diverse personalities.
- Must demonstrate flexibility and ability to adapt to process changes as necessary to meet the needs and goals of the company.
- Support department and organizational goals that contribute to the success of the organization.
- Display self-accountability and embrace personal professional growth and development.
- License and Certification:Membership in the National Association of Medical Staff Services (NAMSS) is encouragedCertified Professional Medical Staff Services Management (CPMSM), Certified Provider Credentialing Specialist (CPCS) are positive attributes for consideration.
EDUCATION/TRAINING/EXPERIENCE:
- Bachelor’s degree in business, healthcare administration or relevant field; or equivalent combination of education and experience.
- Professional Certification is preferred
- Three years of direct Physician interaction.
- Two years of Supervisory experience working
PHYSICAL REQUIREMENTS:
- Requires prolonged sitting, some bending, stooping and stretching
- Must possess sufficient eye-hand coordination/manual dexterity to operate a keyboard, photocopier, telephone, calculator and other office equipment
- Required normal range of hearing and eyesight to record, prepare, and communicate appropriate reports and evaluations.
- Requires lifting papers and boxes weighing up to 35 pounds occasionally
- Requires dexterity to type at least 35 wpm.
WORKING CONDITIONS (environment and safety):
- Work performed in office environment
- Involves frequent contact with professional staff and managed care organizations
- Work may be stressful at times
- Interaction with others is frequent and often disruptive
disclaimer: The above job description has been written to indicate the general nature and level of work performed by employees within this classification. It is not written to be inclusive of all duties, responsibilities and qualifications required of employees assigned to this job.
US Anesthesia Partners, Inc. provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, gender identity, sexual orientation, pregnancy, status as a parent, national origin, age, disability (physical or mental), family medical history or genetic information, political affiliation, military service, or other non-merit based factors.
