Credentialing Manager - Medical Staff Office - FT - Day

Position Status:

Full time

Shift:

First Shift (Days - Less than 12 hours per shift) (United States of America)

Hours per week:

40

Job Information
Exemption Status: Exempt

A Brief Overview
The Credentialing Manager leads strategies for the administrative and functional oversight of the credentialing and provider enrollment database to ensure a quality credentialing and privileging program, enhance the medical staff and team experience and meeting regulatory requirements (SVH Bylaws, TJC, NCQA, other regulatory bodies and oversight) and coordination pertaining to compliance with payer panels metrics, trended data at diverse levels of stratification, and utilization of data effectively through an integrated stakeholder process for inpatient, outpatient and ambulatory care services. This position assists with daily tasks in areas of responsibility as directed by the Director, SVH Administration and the Medical Staff. The Manager works closely collaborates with numerous positions and departments throughout the organization, assists with the execution of the audit process, delivery of high-quality reports and communication throughout SVH. The Credentialing Manager maintains favorable relationships with all levels of management and governance, and accrediting bodies. Assists in the development, planning and operational management of the MD Staff (Credentialing, Privileging, Payer Enrollment), MD STAT (Peer Review, OPPE, FPPE), marketing and SVNET and, EPriv federal and report builds. This position is responsible for ensuring the program's security and integrity to the accrediting bodies standards. Must demonstrate knowledge about established and evolving medical staff bylaws, regulatory requirements, privileging, OPPE/FPPE, provider enrollment, governmental requirements (Medicare, Medicaid, etc.) and NCQA regulations and the application of this knowledge. Provides general administrative support to the Medical Staff in this regard. This individual is responsible for being a leader and educator to Credentialing team members in best practices and must maintain working knowledge of credentialing and privileging and the software.

Education Qualifications

• Associate's Degree Required
• Bachelor's Degree or 5 years direct medical staff office/credentialing privileging experience may be substituted for education Required

Experience Qualifications

• 5 years Medical staff Credentialing experience Required
• Proficiency in Microsoft office. Required
• 3 years Working knowledge credentialing software/process. Required
• 1 year Computer programming data management to include initial, reappt, FPPE, OPPE, Peer Review for streamlining process (change management). Required
• 1 year Leadership/Supervisory experience Preferred

Skills and Abilities

• Professional Ethics, Communication, Professional Presence, Relationship Building, Analytical Thinking, People Management.
• Ability to read, analyze and interpret general business periodicals, professional journals, technical procedures, legal, accrediting and regulatory information.
• Demonstrate excellent writing skills to develop and write business correspondence, reports and procedure manuals accurately and in accordance with recognized standards (grammar, punctuation) for the English language.
• Exhibit oral communication skills (tact, diplomacy etc.) to represent and respond to information for a broad audience including, but not limited to, managers, physicians, outside regulatory agencies, customers and the public.
• Ability to understand and communicate utilizing appropriate medical terminology.
• Demonstrates respect for all individuals (visitors, peers, customers and team members) and helps create and maintain teamwork within the work environment, which contributes to meeting the goals and objectives of the Medical Staff Services department and reflects the mission and values of Stormont Vail Health.

Licenses and Certifications

• Certified Provider Credentialing Specialist - NAMSS Preferred
• Certified Professional Medical Services Management - NAMSS Preferred
• MD-Staff Certified Specialist, Certification Level 2 years Preferred

What you will do

• Ensuring accuracy of data in software/management of software.
• Compile data, maintains data systems, analyzes data and report to the Director of recommended changes and best practices for improvement of system for medical staff functions to include turnaround of medical staff applications. Provides requested reports to internal and external customers. Research, development of drafts of delineation of privileges, OPPEs, FPPES and assist with the presentation and approval as directed.
• Performs functions and duties as a supervisor to include but not limited to management of staff schedules, Workday, ShiftWizard, etc. Timekeeper to include management of time off request, attendance records, and shall act as the delegated designee of the Director. Complete performance evaluations of supervised staff members. Shall be the alternate to the Director.
• Credentialing, Privileging & Auditing Credentialing Files of Category 2 applications and other as directed. Will serve as the Lead for the Credentialing Team. Shall be the Director designee in her absence and available to SVH Administration during any downtime. *Management of data for provider and clinician performance profiles, department/service line profiles and ad hoc data queries. *Provide data abstraction, analysis and reporting of trends related to defined outcomes. Compiles, analyzes and presents clinical improvement information to appropriate organizational and medical staff committees. *Maintain knowledge of evidence-based, CMS and TJC clinical metrics and, as needed, serve as a subject matter expert to support development of effective clinical performance benchmarks, peer review triggers and clinical performance monitoring. Serve as subject matter expert consultant to provide guidance to peer review processes for non-provider specialties to assure consistent compliance with regulatory, accreditation and clinical improvement processes. *Responsible for meeting current goal time frame of processing applications.
• Education and training of credentialing staff.
• Ability to speak to and address all customers as the subject matter expert in credentialing and privileging.
• Participation in delegated payer panel audits.
• Education of the MD-Staff software throughout the organization.
• Will process credentialing files as directed.

Required for All Jobs

• Complies with all policies, standards, mandatory training and requirements of Stormont Vail Health
• Performs other duties as assigned

Patient Facing Options

• Position is Not Patient Facing

Remote Work Guidelines

• Workspace is a quiet and distraction-free allowing the ability to comply with all security and privacy standards.
• Stable access to electricity and a minimum of 25mb upload and internet speed.
• Dedicate full attention to the job duties and communication with others during working hours.
• Adhere to break and attendance schedules agreed upon with supervisor.
• Abide by Stormont Vail’s Remote Worker Policy and will review and acknowledge the Remote Work Agreement annually.

Remote Work Capability

• Hybrid

Scope

• Has Supervisory Responsibility
• 
  
• Has Budget Responsibility

Physical Demands

• Balancing: Rarely less than 1 hour
• Carrying: Rarely less than 1 hour
• Climbing (Stairs): Rarely less than 1 hour
• Eye/Hand/Foot Coordination: Rarely less than 1 hour
• Feeling: Rarely less than 1 hour
• Grasping (Fine Motor): Frequently 3-5 Hours
• Grasping (Gross Hand): Frequently 3-5 Hours
• Handling: Rarely less than 1 hour
• Hearing: Frequently 3-5 Hours
• Kneeling: Rarely less than 1 hour
• Lifting: Rarely less than 1 hour up to 10 lbs
• Operate Foot Controls: Rarely less than 1 hour
• Pulling: Rarely less than 1 hour up to 10 lbs
• Pushing: Rarely less than 1 hour up to 10 lbs
• Reaching (Forward): Rarely less than 1 hour
• Reaching (Overhead): Rarely less than 1 hour
• Repetitive Motions: Rarely less than 1 hour
• Sitting: Continuously greater than 5 hours
• Standing: Occasionally 1-3 Hours
• Stooping: Rarely less than 1 hour
• Talking: Frequently 3-5 Hours
• Walking: Occasionally 1-3 Hours

Working Conditions

• Dusts: Rarely less than 1 hour
• Noise/Sounds: Occasionally 1-3 Hours
• Other Atmospheric Conditions: Rarely less than 1 hour

Stormont Vail is an equal opportunity employer and adheres to the philosophy and practice of providing equal opportunities for all employees and prospective employees, without regard to the following classifications: race, color, ethnicity, sex, sexual orientation, gender identity and expression, religion, national origin, citizenship, age, marital status, uniformed service, disability or genetic information. This applies to all aspects of employment practices including hiring, firing, pay, benefits, promotions, lateral movements, job training, and any other terms or conditions of employment.

Retaliation is prohibited against any person who files a claim of discrimination, participates in a discrimination investigation, or otherwise opposes an unlawful employment act based upon the above classifications.