Credentialing Manager
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Job Description
Manager of Credentialing overseeing provider qualifications and compliance with regulatory standards for Health System. Leadership and management of credentialing processes and quality measures required.
Responsibilities:
- Provides leadership assistance to the operations of assigned department(s).
- Responsible for Credentialing and Primary Source Verification.
- Manages the entire Credentialing of providers for the Health System as it applies to NCQA, Joint Commission, DOH, CMS, DPW and other applicable regulatory standards to the credentialing and privileging processes within the system.
- Oversees reviews and analysis of physician applications and credentialing documents including certificates of education, residency and fellowship training, board certification and eligibility, licensure, professional work history, liability insurance and malpractice history.
- Assess completeness of information and providers' qualifications relative to established standards.
- Works with team to identify potential issues and flags adverse information from application materials for the purpose of obtaining necessary information in preparation for Credentials Committee review.
- Works with Legal Services/Risk Management to assist in answering interrogatories, hospital affiliation information and other legal inquiries regarding provider credentialing and privileging issues.
- Responsible for oversite of DOH, Joint Commission and NCQA survey visits for the credentialed providers of the Geisinger System.
- Oversees all delegated credentialing activities for GHS managed care contracts.
- Performs and reports oversight review findings to leadership.
- Supplies requested policy information, coordinates any oversight reviews, and responds to information requests from managed care organizations for GHS delegations for employed Geisinger Clinic physicians.
- Handles accounting functions for delegated entities (billing for payments).
- Works with Third Party Contracting staff to review all contracts for delegated functions prior to implementation.
- Works closely with Geisinger System Executive leadership, Service Line leadership, clinical directors, and Legal Services to develop strategic goals and processes for credentialing for the Health System.
- Manages the training and education of staff of service lines with respect to System and policies, procedures, and regulatory agency requirements.
- Assures adequate and efficient staffing levels and schedules to meet productivity and quality measures.
- Conducts department staff meetings as necessary and involves staff in decision-making whenever appropriate.
- Communicates the departmental activities to the System Director, Credentialing & Enrollments, AVP Administrative Service with indirect reporting relationship to the Chief Medical Officer /Chief Quality Office and Chairperson of the GHS Credentialing Committee as it relates to issues, with credentialing, privileging processes and doctor master files within the system.
- Prepares Systems Credentials Committee meeting documentation, agendas, minutes and related projects, and policies.
- Maintains both Medical Executive Committee and Board reports related to Credentialing.
- Maintains and supplies provider data to assist with preparation of surveys, directories, websites, marketing proposals, bond reports and other data requests for GHS.
- Maintains a copy Restrictive Covenants for all Geisinger Clinic employed physicians and report new.
- Performs special assignments and participates in special projects at the request of the Executive and Administrative leadership, physician hires and terminations together with documentation of salaries to the Payroll Department monthly.
- Develops credentialing and privileging policies, processes and procedures which meet all regulatory agency requirements.
- Maintains and updates, as needed, all documents, privilege forms and standard letters used in the credentialing processes.
Requirements:
- Bachelor's Degree- (Required)
- Minimum of 5 years-Relevant experience* (Required)
- Minimum of 3 years-Managerial/Supervisory (Required).
- Skills: Acts Decisively, Financial Analysis, Flexibility, Leads Others, Organizing, Problem Solving.
Benefits:
- We offer healthcare benefits for full time and part time positions from day one, including vision, dental and domestic partners.
- Encourages an atmosphere of collaboration, cooperation and collegiality.
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