Credentialing Manager

Job Description Job Description

Credentialing Manager

• About the Role Certifications required: CPMSM and CPCS

The Credentialing Manager provides administrative oversight for the Medical Staff Services department and is responsible for credentialing and privileging activities for professional medical staff and allied health staff. This role coordinates appointment and reappointment processes in accordance with hospital bylaws, DNV standards, and applicable state and federal requirements, while serving as a liaison between medical staff, allied health staff, administration, and internal departments.

Key Responsibilities

• Manage and monitor all aspects of the Medical Staff Services Office, including appointment, reappointment, and privileging status, to support accurate and timely credentialing for prospective and active members of the medical staff and allied health staff.
• Collect and analyze credentialing information, prepare approval files, and ensure credentialing and privileging files remain accurate and current.
• Continuously evaluate and improve credentialing and privileging procedures to support compliance with state and federal requirements and DNV standards.
• Interpret, explain, and follow regulatory guidelines, including Medical Staff Bylaws, Credentialing Rules and Regulations, and applicable laws and regulations related to credentialing and privileging.
• Attend medical staff meetings and present credentialing and re-credentialing applicants for approval, as needed.
• Maintain daily credentialing data files and complete initial entry and ongoing maintenance of practitioner information in the Medical Staff Services software program.
• Interface with the Business Office as needed for setup of new providers in the billing system.
• Assist with quality oversight for medical staff processes, including developing action plans based on recommendations from accreditation agencies, Risk Management, Quality Management, Legal, and federal or state regulators.
• Support administrative leadership with corrective actions, summary suspensions, and the hearing and appellate review process, when necessary.
• Maintain open communication with administration, hospital departments, practitioner office staff, and related agencies to identify and resolve issues as they arise.
• Attend local and national Medical Staff Services meetings and conferences.
• Maintain CME credit certificates and totals, and provide providers with updates on current CME status for board certification and recertification.
• Complete check requests for provider licensure, board certification, CME, surgery center, and hospital credentialing fees.
• Complete licensure paperwork and internet applications for providers, and coordinate with external credentialing sources on provider status, licensure, certifications, and CVs.
• Monitor the Oklahoma State Courts Network for new malpractice cases involving providers and respond to interrogatories as needed.
• Perform other duties as assigned.

Minimum Qualifications

• Associate degree or equivalent from a two-year college required.
• Eight (8) years of related experience and/or training in Medical Staff Services required.
• Certifications required: CPMSM and CPCS.

Preferred Qualifications

• Bachelor's degree preferred.

Professional Standards

This role requires a high level of professionalism, service orientation, accountability, and communication. The successful candidate should foster cooperative working relationships, communicate with honesty and mutual respect, take ownership of issues, and remain mindful of the needs of internal and external customers.

What Makes This Opportunity Appealing

• Leadership-level ownership of credentialing, privileging, compliance, and medical staff services operations.
• Collaborative role working closely with administration, department leaders, medical staff leaders, and external credentialing partners.
• Opportunity to contribute to quality oversight, regulatory readiness, process improvement, and provider support.

Pay Details: $65,000.00 to $85,000.00 per year

Search managed by: Jennifer Lansford

Equal Opportunity Employer/Veterans/Disabled

Military connected talent encouraged to apply

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