Supervisor Enterprise Credentialing: Enterprise Credentialing

Hoag•Newport Beach, CA

About The Position

Under the direction of the Executive Director of Enterprise Medical Staff Services and Credentialing (EMSSC), the Supervisor is responsible for leading, coordinating, monitoring, and maintaining processes and related functions. Ensures interpretation and compliance with the appropriate accrediting and regulatory agencies, while developing and maintaining a working knowledge of the statues and laws relating to NCQA standards. Coordinates to manage the functions required to conduct credentialing and privileging activities of the medical staff organization and ensures that the credentialing and privileging activities of the medical staff organization are timely and meet all internal requirements (bylaws, rules and regulations, policies and procedures) while ensuring compliance with external accreditation standards, state laws and Medicare Conditions of Participation. Duties may include, but are not limited to process supervision, application management, verification of credentials, file maintenance (electronic), expirables management, information management, focused review, and direct support of the evaluation and decision-making process. Enterprise Credentialing only This position assists the Executive Director in developing reports for submission to healthcare plans and other regulatory and accrediting bodies. Medical Staff Office only Oversees all functions related to medical staff services, including meeting management, performance monitoring and practitioner competency management. This position assists the EMSSC in developing reports for meetings, including the credentials report for presentation to the Credentials Committee, Medical Executive Committee and Board of Directors.

Requirements

High School diploma, GED, California High Proficiency or equivalent work experience
Proficiency with Microsoft Office Products (Word, Excel, PowerPoint)
Experience specific to NCQA standards
Credentialing database management

Nice To Haves

2 years of lead or supervisory experience in Medical Staff/Credentialing Services in an acute care setting
Associate’s Degree in a healthcare management related major
1+ years of experience with MD Staff, including use of MD-App
Certified Professional Credentialing Analyst (CPCS)
Certified Professional Medical Services Professional (CPMSM)

Responsibilities

Leading, coordinating, monitoring, and maintaining processes and related functions.
Ensuring interpretation and compliance with appropriate accrediting and regulatory agencies.
Developing and maintaining a working knowledge of statutes and laws relating to NCQA standards.
Managing functions required to conduct credentialing and privileging activities of the medical staff organization.
Ensuring credentialing and privileging activities are timely and meet internal requirements (bylaws, rules and regulations, policies and procedures).
Ensuring compliance with external accreditation standards, state laws, and Medicare Conditions of Participation.
Process supervision.
Application management.
Verification of credentials.
File maintenance (electronic).
Expirables management.
Information management.
Focused review.
Direct support of the evaluation and decision-making process.
Assisting the Executive Director in developing reports for submission to healthcare plans and other regulatory and accrediting bodies.
Overseeing all functions related to medical staff services (Medical Staff Office only), including meeting management, performance monitoring, and practitioner competency management.
Assisting the EMSSC in developing reports for meetings, including the credentials report for presentation to the Credentials Committee, Medical Executive Committee, and Board of Directors.