Medical Staff Credentialing Director is responsible for all aspects of the verification process for medical staff incumbents. Provides regulatory oversight and guidance to the credentialing process. Being a Medical Staff Credentialing Director maintains working knowledge and ensures continuing compliance with state, federal, and institutional standards and guidelines. Develops and implements policies and protocols related to medical staff verifications and ensures that the organization and staff are in accordance with organizational and industry standards. Additionally, Medical Staff Credentialing Director analyzes reports on applications and credential status to identify trends and improve the credentialing process. Presents files to the credentialing committee and may act as a liaison to state medical licensure boards regarding the status of license applications. Requires a bachelor's degree. May require Certified Provider Credentialing Specialist (CPCS). Typically reports to senior management. The Medical Staff Credentialing Director typically manages through subordinate managers and professionals in larger groups of moderate complexity. Provides input to strategic decisions that affect the functional area of responsibility. May give input into developing the budget. To be a Medical Staff Credentialing Director typically requires 3+ years of managerial experience. Capable of resolving escalated issues arising from operations and requiring coordination with other departments. (Copyright 2024 Salary.com)
Summary
Position Summary
Reporting to the Sr. Director of Credential Verification and Regional Medical Staff, the Manager of Credentialing & Medical Staff Compliance is responsible for the development, implementation, and monitoring of comprehensive compliance policies and procedures that ensure compliance with organizational, industry, and regulatory standards. This leader will build and maintain a compliance infrastructure (including creating and updating of local database(s) and tracking logs), data mining, development and implementation of internal audit plan(s) and develop a compliance mandatory training program for new employees of the Credentialing Verification team (CV) and Medical Staff Offices (MSO). Furthermore, the Manager of Credentialing and Medical Staff Compliance will be responsible for identifying performance improvement opportunities and implementing measures to address areas of non-compliance. The incumbent will develop monitoring and auditing tools to ensure compliance with policies and procedures, applicable laws, and contractual obligations.
Required Minimum Knowledge, Skills, and Abilities (KSAs)