• Develops annual operating budget for the Department of Credentialing. Manages expenditures to assure the department operates within budget.
• Develops departmental policies and procedures to ensure compliance with all applicable standards.
• Ensures timely processing of all credentialing requests.
• Manages the outstanding credentialing report related to payor credentialing. Interviews, hires, trains, evaluates, counsels and disciplines staff.
• Assures proper maintenance of credentialing software.

Med Staff & Payor Credentialing: Manages the Medical Staff and Payor Credentialing (auditing) for LifeBridge Health.

• Coordinates initial and reappointment files to the Staff Privileges and Credentialing Committee.
• Maintains a thorough understanding of medical staff bylaws, Joint Commission standards and hospital policies and procedures.
• Recognizes legal implications of committee and/or department actions regarding medical staff membership; recommends use of legal counsel when indicated.

Payor Credentialing: Maintains payor credentialing reporting.

• Reconciles payor credentialing report from billing office.
• Identifies what follow up is necessary to be reimbursed.
• Communicates the outstanding information to Revenue Cycle and Faculty Practice Plan meetings monthly.
• Coordinates the preparation of and oversees audits by third party payors.

Customer Service: Displays quality customer service to internal and external customers.

• Responds to all customer service issues.
• Displays an understanding and awareness of the Hospital's Mission and Vision statements.
• Displays a commitment to the value of teamwork by building strong relationships with internal and external customers.
• Collaborates in the performance of duties to promote a unified and spirited workplace.

QUALIFICATIONS AND REQUIREMENTS:

• Basic professional knowledge; equivalent to a Bachelor's degree; working knowledge of theory and practice within a specialized field
• 5-7 years of experience
• CPCS or CPMSM certification within 3 years