Manager, Medical Staff Credentialing
Company: Cambridge Health Alliance
Location: Cambridge
Posted on: June 21, 2022
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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
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