Supervisor Enterprise Credentialing: Enterprise Credentialing
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. This position assists the Executive Director in developing reports for submission to healthcare plans and other regulatory and accrediting bodies. The Medical Staff Office functions related to medical staff services, including meeting management, performance monitoring and practitioner competency management are also overseen. 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
- Working knowledge of statutes and laws relating to NCQA standards.
- Understanding of internal requirements (bylaws, rules and regulations, policies and procedures).
- Understanding of external accreditation standards, state laws and Medicare Conditions of Participation.
Responsibilities
- Leading, coordinating, monitoring, and maintaining processes and related functions for Enterprise Credentialing.
- 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 for credentialing and privileging activities of the medical staff organization.
- Ensuring credentialing and privileging activities are timely and meet internal requirements.
- 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.
- Developing reports for submission to healthcare plans and other regulatory and accrediting bodies.
- Overseeing all functions related to medical staff services, including meeting management, performance monitoring and practitioner competency management.
- Developing reports for meetings, including the credentials report for presentation to the Credentials Committee, Medical Executive Committee and Board of Directors.
Stand Out From the Crowd
Upload your resume and get instant feedback on how well it matches this job.
What This Job Offers
Job Type
Full-time
Career Level
Manager
Education Level
No Education Listed
