Description

SUMMARY/OBJECTIVE:

The Credentialing Manager will support the Director of Medical Staff Administration and report to the Chief Executive Officer (CEO). Duties include credentialing providers, monitoring expirables, monitoring proctoring, processing OPPE, accurately maintaining credentialing database and other needs as determined by director.

These duties include but are not limited to:

ESSENTIAL FUNCTIONS:

• Adheres to policies and procedures including timely delivery of completed work and use of resources
• Monitors work queue to ensure that applications are processed within a 30 day turnaround time or sooner, if applicable
• Performs credentialing process for all Medical Staff and Advanced Practice Providers at GSSC
• Maintains accurate and complete information in the credentialing database
• Works with practitioners to ensure timely and thorough completion of applications, in compliance with the Medical Staff Bylaws and policies
• Applies general guidelines in determining whether provider meets criteria and documents deficiencies
• Communicates with providers any items that require clarification or additional compliance requirements needed that provider did not supply
• Assembles all verified information and prepares files for presentation to appropriate leadership for recommendations
• Maintains communications with provider offices to promote relationships imperative to process
• Monitors monthly expirables: liability insurance, license, DEAs, Fluoro and other certificates and immunization records
• Monitors ongoing proctoring
• Monitors ongoing OPPE
• Responds to affiliation requests from other facilities
• Generates case logs upon request
• Other duties and projects as assigned

Requirements

POSITION REQUIREMENTS:

• Demonstrates proficiency in credentialing software
• Maintains strict confidence of provider information, ensuring privacy
• Minimum 2 years of experience in credentialing or related field
• Must have a working knowledge of Microsoft Office, including Outlook, Word and Excel
• Maintains current knowledge or NCQA, State and Federal requirements
• Performs data entry and maintains current database for tracking practitioner credentialing and re-credentialing information.
• Certification or training in related area strongly preferred.

SKILLS AND ABILITIES:

• Self-starter with ability to manage multiple priorities
• Detail Oriented
• Communicative
• Problem Solving/Analysis 
• Time management and task completion skills
• Team Player