Regional Director of Credentialing
The Regional Director of Credentialing is responsible for leading, coordinating, monitoring, and maintaining the credentialing and re-credentialing process. Facilitates all aspects of Post Acute Medical, LLC (PAM) credentialing, including initial appointment, reappointment, as well as clinical privileging for Medical Staff, Allied Health Professionals, and all other providers outlined in the PAM Medical Staff Bylaws, policies, or related contracts. Ensures interpretation and compliance with the appropriate accrediting and regulatory agencies, while developing and maintaining a working knowledge of the statutes and laws relating to credentialing. Responsible for the accuracy and integrity of the credentialing database system and related applications. Performs other related duties as assigned or requested. This is an exempt position.

I. Credentialing

• Leads, coordinates, and monitors the review and analysis of practitioner applications and accompanying documents, ensuring eligibility for all applicants within their Region.
• Conducts thorough research and primary source verification of all components of the application file.
• Identifies issues that require additional investigation and evaluation, validates discrepancies and ensures appropriate follow up.
• Delivers the completed credentials file to the Executive Assistant for presentation to PAM Medical Executive Committee and Governing Boards, ensuring file completion within time periods specified.
• Processes requests for privileges, ensuring compliance with criteria outlined in clinical privilege descriptions.
• Responds to inquiries from other healthcare organizations, interfaces with internal and external customers on a day-to-day basis and handles credentialing and privileging issues as they arise.
• Conducts internal file audits, within their Region, to ensure on-going compliance with accreditation standards and on-site file audits prior to accreditation surveys.
• Utilizes the MD Staff credentialing database, optimizing efficiency, and performs query, report and document generation; submits and retrieves National Practitioner Database reports in accordance with Health Care Quality Improvement Act.
• Monitors the initial, reappointment and expirables process for all medical staff, Allied Health Professional staff, Other Health Professional staff, and delegated providers, ensuring compliance with regulatory bodies (Joint Commission, CMS, federal and state), as well as Medical Staff Bylaws, Rules and Regulations, policies and procedures.
• Submit all receipts to Accounts Payable on purchases made for verification purposes
• Submit all expense and travel requests to the Corporate Director of Credentialing for approval
• Provide assistance as needed to the Executive Assistant in regards to monitoring of FPPE/OPPPE, License, DEA and Malpractice Insurance compliance.
• Provides training, if needed, to Executive Assistant in the respective Region on all items concerning credentialing.

II. Customer Service

• Maintains the highest level of customer service via courtesy, compassion and positive communication.
• Promotes the Mission and Vision of Post Acute Medical within the work environment and the community.
• Respects dignity and confidentiality by adherence to all applicable policies and procedures.

III. Health and Safety

• Works in a manner that promotes safety; wears clothing appropriate to the performance of the job.
• Participates in OSHA required training.
• Follows universal precautions as appropriate for position; complies with Employee Health requirements for continued employment.
• Reports unsafe practices to management.
• Knows own role in case of an emergency.

IV. Travel

• Travel to hospitals within or occasionally outside of region as necessary.

POSITION QUALIFICATIONS:
Education and Training: High school diploma or GED. Certification/Licensure NAMSS Certification as a Certified Professional Medical Services Manager (CPMSM) or Certified Provider Credentials Specialist (CPCS) or actively pursuing certification preferred.
Completed degree(s) from an accredited institution that are above the minimum education requirement may be substituted for experience.
Experience: Minimum of at least 4 years of experience with 2 years directly related to hospital medical staff or managed care credentialing.
Knowledge, Skills, and Abilities:

• Ability to communicate effectively, both orally and in writing.
• Knowledge of related accreditation and certification requirements.
• Knowledge of medical credentialing and privileging procedures and standards.
• Ability to analyze, interpret and draw inferences from research findings, and prepare reports.
• Working knowledge of clinical and/or hospital operations and procedures.
• Ability to navigate web-based programs to complete primary source verifications.
• Ability to use independent judgment to manage and impart confidential information.
• Database management skills including querying, reporting, and document generation.
• Ability to make administrative/procedural decisions and judgments.
• Ability to effectively express ideas and views when speaking to groups, hospital managers and staff, and patients/family members.

Job Type: Full-time

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