Medical Staff Office Manager (Credentialing/Privileging), Medical Staff Administration, 40 Hours, Days, Monday through Friday

Hours: 40 Hours, Days, Monday through Friday 

Essential Functions

• Provides direct administrative supervision to employees and escalates concerns to leadership as needed.

• Responsible for ensuring departmental functions are compliant with regulatory requirements and procedures.

• Serves as point of contact and subject matter expert for credentialing.

• Reviews and coordinates policy updates with the Chief Medical Officer.

• Prepares applications for appointments and reappointments of the Medical Staff.

• Monitors and tracks the submission of applications to practitioners, and receipt of completed applications. Communicates updates with shareholders.

• Verifies proper completion and receipt of required documentation for appointments and reappointments in a timely manner.

• Collects, reviews, and documents qualification review cases and decisions in the appropriate system of record.

• Ongoing monitoring of expiration dates for licensures, DEA, state controlled substance and malpractice to secure current documentation at all times.

• Partners with Managed Care Enrollment Specialist so that providers will become contracted providers for managed care plans.

• Provides ad hoc reports from credentialing software.

Statement of Other Duties

This document describes the major duties and responsibilities for this job, and is not intended to be a complete list of all tasks and functions.  It should be understood, therefore, that employees may be asked to perform job-related duties beyond those explicitly described.

Functional Demands

Physical Requirements

Exerts up to 20 pounds of force occasionally, and/or up to 10 pounds of force frequently, and/or a negligible amount of force constantly to move objects.  Frequently reaches (extending hands and arms in any direction), and handles (seizing, holding, grasping, turning, or working with hands).

Job Requirements

Minimum Education

• Graduate of an approved business school and/or a minimum of five to seven years in the Healthcare industry in a hospital, home health, or managed care organization setting, three of which should be working with varying aspects of managed care or case management. Experience must be recent, preferably within the last year.

Minimum Certifications

• CPCS (Certified Provider Credentialing Specialist) certification is preferred.
• CPMSM (Certified Professional Medical Services Management) certification is preferred.

Minimum Experience 

• Prior experience with medical staff and/or Managed Care credentialing preferred.

Required Skills

• Knowledge of computer software required (MS Office Products). 
• Ability to communicate clearly, both orally and written, clerical perception to proofread materials, ability to perform typing, filing, record keeping and communicate with people of various education levels.