JOB DESCRIPTION
Primary Duties and ResponsibilitiesUnder the direction of the Executive Director of Enterprise Medical Staff Services and Credentialing (EMSSC), the Supervisor is responsible for leading, coordinating, monitoring, and maintaining processes and related functions. Ensures interpretation and compliance with the appropriate accrediting and regulatory agencies, while developing and maintaining a working knowledge of the statues and laws relating to NCQA standards. Coordinates to manage the functions required to conduct credentialing and privileging activities of the medical staff organization and ensures that the credentialing and privileging activities of the medical staff organization are timely and meet all internal requirements (bylaws, rules and regulations, policies and procedures) while ensuring compliance with external accreditation standards, state laws and Medicare Conditions of Participation. Duties may include, but are not limited to process supervision, application management, verification of credentials, file maintenance (electronic), expirables management, information management, focused review, and direct support of the evaluation and decision-making process.
Enterprise Credentialing only
This position assists the Executive Director in developing reports for submission to healthcare plans and other regulatory and accrediting bodies.
Medical Staff Office only
Oversees all functions related to medical staff services, including meeting management, performance monitoring and practitioner competency management. This position assists the EMSSC in developing reports for meetings, including the credentials report for presentation to the Credentials Committee, Medical Executive Committee and Board of Directors.
JOB QUALIFICATIONS
Education and Experience
- High School diploma, GED, California High Proficiency or equivalent work experience
- Proficiency with Microsoft Office Products (Word, Excel, PowerPoint)
- Experience specific to NCQA standards
- Credentialing database management
Preferred:
- 2 years of lead or supervisory experience in Medical Staff/Credentialing Services in an acute care setting
- Associate’s Degree in a healthcare management related major
- 1+ years of experience with MD Staff, including use of MD-App
License Required
License Preferred
Certifications Required
Certifications Preferred
- Certified Professional Credentialing Analyst (CPCS)
- Certified Professional Medical Services Professional (CPMSM)
