Credentialing Manager
Location: Dallas Texas
Description: Pinnacle Partners In Medicine is hiring Credentialing Manager right now, this career will be placed in Texas. For detail informations about this career opportunity please read the description below. Summary: This position will direct the daily activities of the Credentialing and Physician Services departments. Provides direct interaction with Hospital Medical Staff Services and other department! s requiring specific Provider related information. In addition this position will maintain positive relationships with all Surgery and OB offices ensuring that information is provided timely and problem resolution is a seamless process. This position will ensure the integrity of all information provided to facilities and or Government agencies while maintaining the utmost confidentiality.
Essential Duties and Responsibilities:
CREDENTIALING:
- Direct the daily activities of the credentialing department.
- Ensure timely and accurate submission of all data to facilities, government agencies and Managed Care Plans.
- Review and submit to candidates to the Pinnacle QI Committee on a monthly basis for new credentialing or re-credentialing evaluations.
- Work with all facility Medical Staff Services and Central Verification Offices to ensure that Pinnacle is current on all primary verification (documents) and other requir! ements as dictated by Medical Staff Bylaw Updates.
- Pa! rticipate in the yearly malpractice insurance renewal process working closely with the CFO, Quality Management and Risk Management department heads.
- Ensure that any issues regarding state medical license, Federal Drug Enforcement Administration (DEA), Texas State Department of Public Safety (DPS), or other pertinent agency data are resolved timely and with the utmost confidentiality.
- Maintain information regarding Continuing Education Opportunities for Providers and oversee data base retention of all Continuing Medical Education (CME) data.
- Work closely with Physician Recruiter and Human resources to maintain accurate physician headcount and status of all recruits.
- Ensure all departmental policies and procedures are documented and maintained on an on-going basis.
- Maintain customer contacts with all levels of personnel, including physicians, division manager’s executive committee, Pinnacle Senior Management Team and a multitude ! of external contacts at all levels.
- Foster a positive work environment and maintain thorough staff retention or recruitment experiences for Credentialing and Provider Enrollment staff. Maintain Departmental budget at or below the yearly projections.
- Maintain data management and work processes in Credentialing Software application. Experience with Morrisey (Apogee) or similar credentialing applications is preferred.
- Performs other duties as assigned.
- Ensure the timely and accurate submission of all Managed Care applications based on Pinnacle Policy and divisional requests.
- Oversee the maintenance of the Managed Care Grid and all related reports.
- Act as a liaison between the Central Business Office and managed care entities to ensure the timely review of applications for effective dates.
- Review potential contracts as requested.
- Maintain the managed care files and contra! ct histories.
- Oversee all new provider managed care projects.
- Direct the daily activities of divisional Physician Service Coordinators.
- Work with all divisions to develop and maintain facility and patient informational material.
- Host meetings, luncheons, etc. for Surgeon and OB staff office as needed to respond to concerns and maintain positive relationships.
- Visit individual Physician offices as needed or requested by divisions.
- Ensure the monthly reconciliation of physician minutes and or cases for designated divisions.
- Respond to Physician Office, Facility and Patient Complaints working closely with risk to ensure satisfaction.
- Manage answering service and call center concerns as needed.
- Attend division meetings and transcribe minutes as requested.
- Act as liaison between CBO and providers regarding account reconciliation.
- Provide a! fter-hour coverage for questions concerns and issues as needed.
- Represent the organization in a positive professional manner.
- Adhere to all company policies and procedures.
- Adherence to and compliance with information systems security is everyone’s responsibility. It is the responsibility of every computer user to: Know and follow Information Systems security policies and procedures, attend Information Systems security training, and to report information systems security problems when they ocurr.
- Staff development through performance evaluations, counseling and disciplinary actions as needed with assigned staff.
- Facilitate individual and team development that drives positive results.
- Perform other duties as assigned.
Education/Licensing/Certification:
- Bachelor’s degree in business, health! care administration or relevant field and three to five years of solid ! Healthcare management experience; or equivalent combination of education and experience.
- Three to Five years of direct Physician interaction.
- Five years of Supervisory/Management experience working
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If you were eligible to this career, please email us your resume, with salary requirements and a resume to Pinnacle Partners In Medicine.
If you interested on this career just click on the Apply button, you will be redirected to the official website
This career starts available on: Mon, 04 Nov 2013 22:42:11 GMT