Manager, Medical Staff Credentialing

Company: Cambridge Health Alliance
Location: Cambridge
Posted on: June 21, 2022

Job Description:

Location: CHA Cambridge Hospital Work Days: 8am to 4:30pm / variable Category: Professional and Management Department: Medical Staff Office Job Type: Full time Work Shift: Day Hours/Week: 40Union: No Union Name: Non UnionDEPARTMENT DESCRIPTION:The department is responsible for the general management of all medical staff services functions including: credentialing, continuing medical education, and medical staff committee support. Summary:Under the direction of the Senior Director of Medical Staff Services, the Manager of Medical Staff Services will oversee and be responsible for the general management of all medical staff services functions include: credentialing, continuing medical education, and medical staff committee support. Coordinates and performs a variety of administrative duties required for provider enrollment with third-party insurance plans.Responsibilities:Credentialing and Provider Enrollment Assist Senior Director in supervising the credentialing and provider enrollment processes. Ensures credentialing of applicants for membership and appointment is coordinated accurately and timely in compliance with defined schedules. Coordinates primary source verification of initial and reappointment applications Oversees the collection of information by Credentials Coordinators to identify potential quality care issues, behavioral problems, appropriate education and training. I Leads the Credentialing Coordinators' team efforts to provide quality services to all customers Investigates issues of concern regarding applications, generates reports, and presents findings to the Senior Director as appropriate. Coordinates and monitors implementation and maintenance of accurate and up-to-date computerized database and credentials files for members of the Medical Staff and Allied Health Professionals. Assists the Senior Director in bringing about an enhancement of relationships with physicians by working effectively with physician leaders, new medical staff members, and physician office personnel. Serves as resource to Credentials Coordinators with regard to processes in credentialing and provider enrollment Identifies substantive issues and initiates further data collection as needed from internal and external sources Maintains understanding of NCQA, Joint Commission and state credentialing regulations Updates and maintains specialized databases, including but not limited to CAQH, HCAS and NPI registry to support the efficient maintenance and utilization of provider enrollment information Maintains working knowledge of credentialing verification databases and resources such as National Practitioner Data Bank, American Board of Medical Specialties and AMA profiling Maintains online clinical privileging database to insure effective communication of current privileges. Coordinates program changes with Senior Director and IT support. Supervises completion of applications to third party payers, tracks enrollment process and maintains application status in Intellicred database Participates in the planning, evaluation, revision of departmental policies, processes, and systems Monitor integrity of departmental credentialing software and communicates issues to Senior Director Assists Senior Director in thorough review of medical staff bylaws, Joint Commission standards, CHA policies Monitors expiring documentation reminder system Manage technical and administrative projects for the medical staff and provider enrollment as directed by Senior Director Develops and maintains a good working rapport with members of the Medical and Allied Health staff, and hospital personnel. Researches, facilitates and assists with resolution of issues related to provider enrollment, keeping Senior Director informed of progressContinuing Medical Education Serves as primary contact with Harvard Medical School Continuing Education program Manages submission of all CME reporting Manages CME Annual Needs Assessment and collects information from multiple departments Prepares annual and interim reports for HMS to insure continuing compliance with certification for continuing medical education programs at CHA Serve as resource for medical staff in setting parameters of goals and objectives for CHA CME programs to comply with HMS guidelinesMINIMUM QUALIFICATIONS:Other information:Equivalent years in a dynamic health care setting or related field can be substituted for the required experience.Certifications: National Association Medical Staff Services CPCS or CPMSM preferredWork Experience: One to three years of experience required in a healthcare setting in an administrative capacity. Previous credentialing experience in a hospital medical staff office or managed care organization preferred. In keeping with federal, state and local laws, Cambridge Health Alliance (CHA) policy forbids employees and associates to discriminate against anyone based on race, religion, color, gender, age, marital status, national origin, sexual orientation, gender identity, veteran status, disability or any other characteristic protected by law. We are committed to establishing and maintaining a workplace free of discrimination. We are fully committed to equal employment opportunity. We will not tolerate unlawful discrimination in the recruitment, hiring, termination, promotion, salary treatment or any other condition of employment or career development. Furthermore, we will not tolerate the use of discriminatory slurs, or other remarks, jokes or conduct, that in the judgment of CHA, encourage or permit an offensive or hostile work environment.

Keywords: Cambridge Health Alliance, Cambridge , Manager, Medical Staff Credentialing, Healthcare , Cambridge, Massachusetts