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)
US:NV:Carson City Medical Staff Support Services
Full Time
About Carson Tahoe Health
CTH is a not-for-profit healthcare system with 240 licensed acute care beds, fully accredited by the Center for Improvement in Healthcare Quality (CIHQ). CTH was voted 5th most beautiful hospital in the nation nestled among the foothills of the Sierra Nevada in North Carson City and only a short drive away from world-famous Lake Tahoe & Reno. We serve a population of over 250,000 and feature two hospitals, two urgent cares, an emergent care center, outpatient services and a provider network with 19 regional locations.
Summary
Under direction of the Senior Credentialing Specialist, the Credentialing Specialist participates in Department activities to ensure quality in conducting, maintaining, and communicating physician credentialing, privileging, and primary source verifications. This position collaborates with others to advance the quality of practitioners and patient safety of the facility.
Responsibilities
• Conducts, participates in and maintains credentialing and privileging
• Determines applicant`s initial eligibility for membership/participation
• Analyzes application and supporting documents for completeness and informs the practitioner of the application status, including the need for any additional information
• Performs initial and reappointment/re-credentialing for eligible practitioners
• Conducts, participates in and maintains primary source verification
• Recognizes, investigates and validates discrepancies and adverse information obtained from the application, primary source verifications or other sources.
• Verifies and documents expirables using acceptable verification sources to ensure compliance with accreditation and regulatory standards.
• Provides responses to external queries regarding practitioners` status.
• Uniformly applies clearly defined credentialing or privileging processes to all practitioners/providers.
• Audits, assesses, procures, implements, effectively utilizes and maintains practitioner/provider credentialing process and information systems by analyzing the needs and resources of medical services/credentialing.
• Maintains credentialing database to ensure that accurate and current information is available to all stakeholders.
• Assists the Medical Staff office in providing all credentialing, privileging and meeting support activities for Carson Tahoe Health and Medical Staff leadership.
• Implements the physician enrollment and credentialing process for providers across the Carson Tahoe Health System. Maintain the timelines on enrollment/credentialing schedules, communicate with providers and other departments to update as needed, clarify carrier information requirements, and maintain a strict level of confidentiality for all matters pertaining to provider credentials.
• Coordinates credentialing data needed for enrollment, contracting, and other related purposes. Credentialing data includes but is not limited to the medical degree, Drug Enforcement Administration (DEA) number, state license number, Board certifications, CV, malpractice insurance and state insurance form.
• Works closely with Physicians to obtain missing documentation for providers pertaining to provider enrollment. Obtains appropriate authorized signatures and follows up with the carriers on documentation submitted.
• Performs other related duties as assigned.
Qualifications
• Required o High School Diploma or equivalent o One year experience in a position with responsibilities relating to Medical Staff credentialing o Understanding of Medical Staff Governance and Peer review processes o Knowledge of medical insurance carrier policies and procedures, State and Federal rules and regulations • Preferred o Credentialing experience in Acute Healthcare setting o Certified Provider Credentialing Specialist (CPCS) certification through NAMSS o Notary Public for the State of Nevada
Top 5 Reasons to Live in Carson City, Nevada
Our Benefits