Credentials Manager, Medical Staff

South Shore Health•Weymouth, MA

3d•$103,000 - $153,700•Onsite

About The Position

The Medical Staff Credentials Manager is a key leadership role responsible for overseeing the credentialing and re-credentialing process for all providers at South Shore Health. The Credentials Manager oversees the credentialing and re-credentialing processes for healthcare providers, ensuring compliance with federal and state regulatory requirements, medical staff bylaws and organizational policies. Reporting to the Director of Medical Staff Affairs, this role manages the verification of provider qualifications, coordinates with insurance networks, and maintains accurate credentialing databases. This is an excellent career development opportunity! The Credentials Manager oversees the timely credentialing, re-credentialing, and clinical privileges of all South Shore Health providers. They are responsible for ensuring the integrity, accuracy, and completeness of provider records and database entries. This includes collaborating with physician leadership to develop and revise privilege forms as needed. In this role, the incumbent provides guidance and direction to the Medical Staff coordinators, and occasionally other staff, on special projects. They are responsible for the training, mentoring, professional development, and evaluation of the credentialing team. The Manager also frequently assesses departmental productivity and develops business strategies to ensure effective operations. Ensuring compliance with The Joint Commission (TJC), National Committee for Quality Assurance (NCQA), and the organization's Medical Staff Bylaws, Rules and Regulations is a key aspect of this position. Coordinates the Credentials Committee and other assigned medical staff committees, managing agendas, minutes, reports, and follow-up. This role requires a strong understanding of the FPPE and OPPE processes, as the Manager oversees and manages these critical provider evaluation activities. The Credentials Manager must exemplify a culture of excellence and customer service, serving as a positive representative of South Shore Health both internally and externally.

Requirements

Completion of a graduate or undergraduate degree in healthcare or related field, or equivalent related experience commensurate with a graduate or undergraduate degree.
A minimum 5 years working in a medical staff office or CVO with at least 2 years supervisory/managerial experience.
Knowledge of credentialing database system(s) and associated applications strongly preferred.
Excellent interpersonal and communication skills.
Ability to work under minimal supervision and to adapt quickly to changes within the environment.
Knowledge of Verity/Credentialstream or similar credentialing software.
Demonstrate an understanding of the job description, performance expectations, and competency assessment.
Capacity to work autonomously and in partnership with healthcare teams.
Inspire innovative thinking and encourage creative ideas and imaginative solutions to issues or problems.
Use Microsoft Office (Access, Excel, PowerPoint, and Outlook) and financial systems.
Maintain the highest standards of performance, quality, credibility, and integrity.
Demonstrate extraordinarily professional discretion in the handling of highly confidential and/or political information and data.

Nice To Haves

Certified Provider Credentialing Specialist (CPCS) or Certified Professional in Medical Staff Management (CPMSM) strongly preferred or willingness to achieve said certifications within 2 years.

Responsibilities

Credentialing and Re-credentialing
Collaborates with the Director of Medical Staff Services/Affairs, Medical Staff Leadership, and Hospital Leadership to organize and maintain systems that coordinate the credentialing and re-credentialing process for all South Shore Health credentialed providers.
Manages the timely credentialing, re-credentialing, and clinical privileges of SSH providers.
Oversees the integrity, accuracy, and completeness of applications for new and reappointed staff, collaborating when necessary, with the director and chair of credentials, following established process for problem applications.
Collaborates with the MSSD staff and Hospital Leadership in assisting providers with the application process for timely appointment, reappointment, clinical privileges, and expirable in accordance with Medical Staff Bylaws, Rules and Regulations, hospital policies and procedures and in accordance with The Joint Commission (TJC), CMS and other state and federal regulatory agencies as required.
Database Management
Oversees the integrity, accuracy, and completeness of database entries.
Oversees and manages the maintenance of electronic provider records as required.
Privilege Forms
Collaborates with physician leadership in the development of new, or revision of, current privilege forms as assigned.
Staff Management and Development
Prioritizes work and provides guidance and direction to Medical Staff coordinators and on occasion of other staff assigned to assist with special projects.
Responsible for, in collaboration with the director, the training, mentoring, ongoing professional development, and evaluations of all credentialing team members.
Conducts regular MSSD staff educational sessions.
Operational Efficiency
Frequently assesses the productivity of departmental and develops business strategies to ensure effective business operations.
Policy Compliance
Responsible for the compliance of all medical staff and hospital policies as they pertain to credentialing and education of the medical staff.
Responsible, in collaboration with the Director, for the development of new policies, review and revision of current policies, and the compliance thereto.
Committee Coordination
Coordinates the Credentials Committee, and other medical staff committees (as assigned) to include the agenda, minutes, reports, and any required follow-up.
FPPE and OPPE
Oversees, coordinates and manages the FPPE and OPPE process.
Oversees the integrity of and enforces deadlines for FPPE and OPPE process.
Regulatory Compliance
Maintains a working knowledge of and compliance to The Joint Commission (TJC) and National Committee for Quality Assurance (NCQA) standards as well as of the organization's Medical Staff Bylaws, Rules and Regulations, and applicable medical staff and hospital policies.
Culture and Representation
Exemplifies a culture of excellence and customer service in all processes with all internal and external customers and all external representation of South Shore Health.
Incorporates South Shore Health Standards of Behavior and Guiding Principles into daily activities.
Quality Improvement and Education
Participates in departmental and/or interdepartmental quality improvement activities.
Participates in and successfully completes Mandatory Education.
Performs all other duties as needed or directed to meet the needs of the department.