Medical Staff Office Manager

Nuview Health Boca Raton , FL 33427

Posted 3 months ago

Responsible for leading, coordinating, monitoring, and maintaining the credentialing and re-credentialing process. Facilitates all aspects of NuView Health credentialing, including initial hospital appointment, hospital reappointment, expirables process, medical licensing applications and insurance enrollment. Responsible for the accuracy and integrity of the credentialing database system and related applications. Works under the supervision of the
Chief Operating Officer.Job Duties Include:

    • Work as Liaison between Legal Department, Executives and Physicians to ensure Physician Agreements are created and executed prior to physician onboarding with group.Completes onboarding process of new physician joining the practice.
    • Conduct and oversee thorough background investigation, research and primary source verification of all components of the application file.
    • Manages employees within the Medical Staff Department i.e. Credentialing Coordinators
    • Coordinate meetings / travel arrangements for Executive suite.
    • Prepares various credentialing reports for internal and external status updates as needed
    • Leads, coordinates, and monitors the review and analysis of practitioner applications and accompanying documents, ensuring applicant completion.
    • Identifies issues that require additional investigation and evaluation, validates discrepancies and ensures appropriate follow up.
    • Assists hospital Medical Staff Offices with follow up on outstanding verifications needed to complete practitioners credentialing file, ensuring file completion within time periods specified.
    • Responds to inquiries from other healthcare organizations, interfaces with internal and external clients on day-to-day credentialing and privileging issues as they arise.
    • Utilizes the credentialing database, optimizing efficiency, and performs query, report and document generation.
    • Manages the initial and reappointment process for all medical staff.
    • Assists hospital Medical Staff Offices with review of FPPE and OPPE reviews for each provider to determine if he or she meets minimum contact as mandated by Joint Commission which also establishes criteria for re-appointments.
    • Monitors all expirables for all medical staff.
    • Prepares various initial and renewal state medical license applications for practitioners to review and submit.
    • Responsible for ensuring all medical staff are enrolled in the various insurances as required for each state company conducts business.
    • Coordinate with billing department to ensure all insurance enrollment information is received.
    • Performs miscellaneous job-related duties as assigned.

    Requirements

    • High school diploma or GED;
    • At least 5 years of experience related to insurance / hospital medical staff credentialing.
    • Certification/Licensure - NAMSS Certification as a Certified Provider Credentials Specialist (CPCS) / Certified Professional Medical Services Management (CPMSM) or actively pursuing certification. Preferred*

    Benefits

    • Health Insurance;
    • Dental Insurance;
    • Vision Insurance;
    • Short and Long-Term Disability;
    • Life Insurance;
    • 401K
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