Credentialing Lead

Position Summary

To oversee the day-to-day activities of staff that process credentialing services of the Medical Faculty Associates ("MFA") to ensure compliance with regulatory agency requirements and University and MFA policies and procedures.

Essential Duties and Responsibilities include the following. To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Other duties may be assigned.

Ensures the accuracy and integrity of current files and databases; coordinates filling of credentials and documents into individual faculty and non-faculty provider files; coordinates updating database with changes of address, status and other information

Mentor team by providing guidance and support to ensure high performance and professional development.

Monitor daily tasks, assist in setting priorities, and ensure deadlines are met

Oversee the credentialing process for new and existing providers, ensuring all required documentation is collected, verified, and processed in accordance with credentialing policies and regulatory guidelines.

Assist with managing the credentialing lifecycle, including initial applications, re-credentialing, and ongoing monitoring.

Conduct regular audits of credentialing files and processes to ensure accuracy and compliance.

Assist in addressing and resolving all discrepancies or issues related to provider enrollment and credentialing.

Facilitate communication with external stakeholders.

Assist the manager in the onboarding and department orientation of new employees.

Assist with monthly reports reflecting the status of credentialing activities.

Perform other work-related duties as required by the manager.

Minimum Qualifications

The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education

Bachelor's degree in appropriate field or an equivalent of training and experience

Experience

3 years of experience of professional experience within a managed care/healthcare environment, to include 2 years of experience involving the credentialing/recredentialing of healthcare providers.

Competencies

Ability to do math calculations, input data into the computer, and analyze data as requested. Must be able to communicate providing verbal feedback in a professional manner. Must possess a strong knowledge of credentialing standards, regulatory requirements, and accreditation process. Must be proficient in using the credentialing software and Microsoft Office Suite. Must be able to follow and understand instructions and react favorably in all work situations. Must be detailed oriented with strong organizational and problem solving abilities. Must possess the ability to handle sensitive information with confidentiality and professionalism.

Supervision Received

Supervision is received from the department manager.

Supervision Exercised

Functional supervision over the Credentialing Specialists

Typical Physical Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Frequent mobility and/or sitting required for extended periods of time. Requires manual dexterity to operate computer keyboard, calculator, copier machine, and other equipment.

Working Conditions

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.