Director of Credentialing

LifeBridge Health; Baltimore (MD); On-site; USD 139,138,000 - 223,171,000; Full time

Benefits offered by this job

Medical, dental, and vision coverage

Tuition reimbursement

Paid time off

On-site parking

Job summary

Sinai Hospital seeks a credentialing leader to direct the Credentialing and Payor Credentialing department. You will oversee operations, ensure regulatory compliance, and drive timely processing of credentialing requests across the medical staff and payor processes.

The role requires 5–7 years of credentialing experience, a Bachelor's degree preferred, and CPCS/CPMSM certification within 3 years of hire. Excellent leadership and communication are essential to succeed in this position.

Qualifications

• Bachelor's degree preferred.
• CPCS or CPMSM certification within 3 years of hire.
• Experience: 5–7 years in credentialing management.

Responsibilities

• Directs the overall operations, development and management of the Credentialing/Payor Credentialing department.
• Manages the Credentialing Department and develops annual operating budget.
• Ensures compliance with all applicable standards and timely processing of credentialing requests.
• Interviews, hires, trains, evaluates staff and manages credentialing software.
• Maintains payor credentialing reporting and coordinates audits by third party payors.

Education

Bachelor's Degree preferred

Job description

Summary

Directs the overall operations, development and management of the Department of Credentialing/Payor Credentialing. Ensures that all credentialing and accreditation processes and procedures are completed in accordance with established regulatory and policy requirements.

• Manages the Credentialing Department.
• Develops annual operating budget for the Department of Credentialing.
• Manages expenditures to assure the department operates within budget.
• Develops departmental policies and procedures to ensure compliance with all applicable standards. Ensures timely processing of all credentialing requests.
• Manages the outstanding credentialing report related to payor credentialing.
• Interviews, hires, trains, evaluates, counsels and disciplines staff. Assures proper maintenance of credentialing software. Manages the Medical Staff and Payor Credentialing for LifeBridge Health.
• Coordinates initial and reappointment files to the Staff Privileges and Credentialing Committee.
• Maintains a thorough understanding of medical staff bylaws, Joint Commission standards and hospital policies and procedures.
• Recognizes legal implications of committee and/or department actions regarding medical staff membership; recommends use of legal counsel when indicated. Maintains payor credentialing reporting. Reconciles payor credentialing report from billing office. Identifies what follow up is necessary to be reimbursed.
• Communicates the outstanding information to Revenue Cycle and Faculty Practice Plan meetings monthly.
• Coordinates the preparation of and oversees audits by third party payors.
• Displays quality customer service to internal and external customers. Responds to all customer service issues.
• Displays an understanding and awareness of the Hospital's Mission and Vision statements.
• Displays a commitment to the value of teamwork by building strong relationships with internal and external customers. Collaborates in the performance of duties to promote a unified and spirited workplace.

Experience

5-7 years

Bachelor's Degree preferred

Preferred Certs: Certified Provider Credentialing Specialist, Certified Professional Medical Services Management

Credential Note: CPCS or CPMSM certification obtained within 3 years of hire.

Pay Range: $48.73 to $77.97 (based on experience)

Benefits

• Medical, dental, and vision coverage starting the first of the month after hire, plus wellness programs and mental health support
• 403(b) retirement plan with employer match, pension, and life and disability insurance
• Tuition reimbursement toward advanced degrees and specialty certifications
• Generous paid time off, fitness discounts, and free on-site parking

About Sinai Hospital

Sinai Hospital of Baltimore is a nationally recognized academic medical center, a designated Level II Trauma Center, and the largest community hospital in Maryland. As part of LifeBridge Health - one of the region's most comprehensive healthcare systems - Sinai delivers advanced care with a mission to improve the health of the communities we serve, and to take care of the people who take care of patients.

About LifeBridge Health

LifeBridge Health is a dynamic, purpose-driven health system redefining care delivery across the mid-Atlantic and beyond, anchored by our mission to "improve the health of people in the communities we serve." Join us to advance health access, elevate patient experiences, and contribute to a system that values bold ideas and community-centered care.

With over 14,000 employees, 130 care locations, and two million annual patient encounters, we combine strategic growth, innovation, and deep community commitment to deliver exceptional care anchored by five leading centers in Maryland.

Our organization thrives on a culture of CARE BRAVELY-where compassion, courage, and urgency drive every decision, empowering teams to shape the future of healthcare.

LifeBridge Health complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex or sexual orientation and gender identity/expression. LifeBridge Health does not exclude people or treat them differently because of race, color, national origin, age, disability, sex or sexual orientation and gender identity/expression.