Supervisor, Medical Staff Credentialing

The Medical Staff Credentialing Supervisor will be responsible for successfully supervising the organizational and administrative operations of the Medical Staff Department to ensure that systems are safe, effective, appropriate, and compliant with applicable regulations and standards. Will perform supervisory duties including training, evaluating and the day-to-day management of the Medical Staff team. The Supervisor will be accountable for quality and integrity of data entered into systems and will monitor administrative activities related to the Medical Staff Office. Will work collaborative with the Director to assign work to team members, assuring timely completion of project milestones and deliverables as appropriate. Emphasis is placed on customer services, provider satisfaction, staff development and fiscal goals. Will supervise and oversee all credentialing services, will provide on-boarding assistance to the medical staff, will supervise various information systems used in credentialing functions, and will assist in the process for delegated credentialing including audits. Created and updated DOPs.

Minimum Education
Bachelor's Degree (Required)
Master's Degree (Preferred)

Minimum Work Experience
3 years of credentialing experience (Required)

Required Skills/Knowledge

• Strong organizational and interpersonal and written communication skills.
• Must have the ability to prioritize, delegate, and manage multiple responsibilities.
• Must be able to work independently on assigned tasks and follow through to completion.
• Good supervisory skills.
• Ability to delegate assignments and follow through on details is essential.
• Excellent consumer relations skills.
• Knowledge of physician billing practices, insurance enrollment and credentialing.
• Proficient with Microsoft Word, Excel and Power Point.
• Knowledge of various accreditation standards (JC, NCQA, AAAHC, DOH) and State laws
• Knowledge of CredentialStream (or equivalent) Credentialing Data System

Required Licenses and Certifications
Certified Provider Credentialing Specialist CPCS and CPMSM 2 Yrs (Required)

Grow

• Encourage and share new ways of making the right work easier to do

• Recognize and share incremental improvements in operations

• Monitor and promote efficiency in the team's operations

Credentialing

• Supervises day to day activities of the credentialing services staff.

• Ensures that processes function smoothly and timely manner, including updating Credentialing Data System content and monitoring of credentialing performance metrics based on Credentialing Data System reports and other data sources as needed

• Develops departmental guidelines to ensure compliance with the Medical Staff Bylaws

• Oversees processes and minutes for the Credentials Committee, and assists with the Medical Executive Committee (EC) and Board actions.

• Work in conjunction with business operations in follow-up as needed.

• Provides updated credentials committee actions to managed care for submission to the various payer's

• Assist in delegated credentialing audits. Develops responses and action plans as needed. Submits results to Director, medical affairs for the Credentials Committee.

Program and Service Administration and Implementation

• Supervises processing of initial appointments and reappointments of medical staff

• Conducts audits (QI) of completed appointments and reappointment applications

• Provides education and feedback to staff

• Prepares files for credentials committee actions

• Develops automated processes in CredentialStream (or equivalent) Credentialing Data System for appointments and reappointments

Compliance

• Develops process to ensure that all providers maintain current licensure, health attestations, certifications and insurance certificates

• Provides list of providers to be deferred monthly for medical staff action

• Develops automated processes in CredentialStream (or equivalent) Credentialing Data System for tracking licensure, etc. and sending notifications

Customer Service

• Supervises staff in physician on-boarding, to include assisting new doctors in application process for obtaining appropriate licensure, as well as medical staff privileges.

• Develops and applies metrics around time of hire, medical staff application date, licensure application, licenses granted and medical staff privileges approved.

• Trains staff in customer service activities and maintains high level of customer service.

• Develops automated processes in CredentialStream (or equivalent) Credentialing Data System to assist in on-boarding process.

Leader Accountabilities Supervisor

Deliver

• Provide clear and visible team goals and priorities

• Manage achievement of team goals and priorities

• Provide input on the team budget and operational priorities

• Monitor the use of resources and provide guidance to staff

• Implement procedures to ensure high safety and quality, and course-correct as needed

• Ensure service excellence in meeting the customer's needs

Engage

• Help staff understand the impact of organizational strategies on the team's work

• Provide prompt and clear verbal and written feedback to staff and manage/guide their performance

• Establish and maintain a positive working environment

• Ensure adherence to organizational regulations

• Assist in recruiting talents and developing their capabilities

• Support the Director in promoting strong employee engagement

Grow

• Encourage and share new ways of making the right work easier to do

• Recognize and share incremental improvements in operations

• Monitor and promote efficiency in the team's operations