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)
Location | US-MO-Kansas City | ID | 2024-163738 | Category | Business Professional | Position Type | Full Time | Shift | Days | Job Type | Non-Exempt |
At St. Joseph Medical Group and Kansas City Physician Care, our dedicated team of professionals is committed to our core values of quality, compassion, and community. Affiliated with St. Joseph Medical Center, St. Joseph Medical Group and Kansas City Physician Care are actively seeking new members to join their award-winning teams!
Company is an equal employment opportunity employer. Company prohibits discrimination against any applicant or employee based on race, color, sex, sexual orientation, gender identity, religion, national origin, age (subject to applicable law), disability, military status, genetic information or any other basis protected by applicable federal, state, or local laws. The Company also prohibits harassment of applicants or employees based on any of these protected categories. Know Your Rights: https://www.eeoc.gov/sites/default/files/2022-10/EEOC_KnowYourRights_screen_reader_10_20.pdf
Responsible for tracking provider enrollments, re-credentialing, and new contract applications with commercial and government health plans. Perform CAQH maintenance. Effectively communicate the contracting and enrollment process, addressing and providing regular updates to Regional Directors. Possess comprehensive knowledge of managed care company and plan requirements. Monitors and maintains websites for pending revalidations and credentialing requests.
EDUCATION, EXPERIENCE, TRAINING
1. Associates degree preferred or equivalent education/experience.
2. Certified Provider Credentialing Specialist (CPCS) preferred
3. Must have strong computer, communication, and writing skills.
4. Must be proficient in Microsoft Office: Word, Excel, and PowerPoint.
5. Must exhibit a positive attitude and willingness to learn. 6. Knowledge of managed care plans, PECOS, NPPES,CAQH
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