Manager of Provider Credentialing

Cape Fear Valley Health; Fayetteville (NC); On-site; USD 90,000 - 130,000; Full time

Job summary

Cape Fear Valley Health is seeking an experienced leader to oversee the Medical Staff Services Department, directing credentialing, privileging, and reappointment across the Health System. You will develop and refine policies and workflows to ensure ongoing regulatory and accreditation compliance while serving as a liaison between executives, leaders, and providers.

Responsibilities include coordinating committees, supervising credentialing staff, and supporting physician contracts.

Qualifications

• Proficiency in reading, writing, and speaking the English language.
• Ability to exercise judgment and tact with physicians, staff, and executives.
• Maintains confidentiality of sensitive information.
• Strong organizational and communication skills.
• Knowledge of medical staff and hospital administration functions.

Responsibilities

• Oversee credentialing, privileging, and reappointment processes.
• Coordinate Joint Credentials Committee meetings and minutes.
• Direct operations of centralized credentialing with process improvements.
• Ensure compliance with Joint Commission, CMS and state requirements.
• Support Medical Staff governance and physician contract administration.
• Prepare and maintain monthly ED unassigned call schedule.
• Assist the CMO with contracts and reimbursements.

Education

Associate Degree in Business Administration, Healthcare Administration, Medical Staff Services Sciences or related field

Job description

Responsible for the daily leadership and operational oversight of the Medical Staff Services Department, ensuring the efficient administration of provider credentialing, privileging, and reappointment processes across the Health System. Plans, develops, implements, and continuously improves departmental operations, policies, and workflows to ensure compliance with accreditation, regulatory, and Medical Staff standards. Serves as a key liaison between executive leadership, Medical Staff leadership, providers, and administrative departments, fostering effective communication, collaboration, and strong working relationships. Supports Medical Staff governance through coordination of credentialing activities, committee operations, regulatory compliance, and physician contract administration while promoting high-quality, efficient, and compliant Medical Staff Services.

Major Job Functions

The following is a summary of the major essential functions of this job. The incumbent may perform other duties, both major and minor, that are not mentioned below. In addition, specific functions may change from time to time:

• Collaborate with the Corporate Director and Medical Staff leadership across the Health System to support the successful execution of leadership responsibilities, including oversight of the Joint Credentials Committee (JCC) and individual facility Executive Committees.
• Assist the Corporate Director in directing the operations of the centralized credentialing department by developing, implementing, monitoring, and continuously improving processes that support the credentialing and reappointment of all providers.
• Coordinate workflow assignments and oversee the performance and productivity of Credentialing Specialists to ensure timely and accurate completion of credentialing activities.
• Coordinate and attend Joint Credentials Committee meetings; prepare meeting agendas and minutes, distribute follow-up correspondence, and facilitate action items and committee-related activities.
• Perform quality reviews of initial appointment and reappointment credentialing files, identify discrepancies or deficiencies, and ensure all issues are resolved before committee review.
• Coordinate the timely electronic review of completed credentialing files by Medical Staff leadership and Joint Credentials Committee members.
• Collaborate with Performance Improvement, Risk Management, and other departments to ensure identified trends, quality concerns, and potential risk issues are appropriately reviewed and addressed in accordance with Health System policies and Medical Staff Bylaws.
• Ensure compliance with applicable accreditation, regulatory, and Medical Staff standards across the Health System by maintaining current knowledge of Joint Commission, CMS, state, and other regulatory requirements.
• Coordinate and attend Medical Staff committee meetings, including Endovascular Committee, Bylaws Committee, and designated Department and Section meetings, ensuring accurate documentation, effective communication, and timely follow-up of committee recommendations.
• Prepare and maintain the monthly Emergency Department unassigned call schedule, ensuring accuracy and timely distribution.
• Assist the Chief Medical Officer with the administration and oversight of designated Medical Staff contracts, including coordination of physician reimbursements and related administrative processes.
• Other duties as assigned

Minimum Qualifications

The following qualifications, or equivalents, are the minimum requirements necessary to perform the essential functions of this job:

Education and Formal Training:

• Associate Degree in Business Administration, Healthcare Administration, Medical Staff Services Sciences or related field required
• Certification by National Association Medical Staff Services is preferred

Work Experience:

• 3 years of experience in medical staff services management or related field required

Knowledge, Skills, and Abilities Required:

• Proficiency in reading, writing, and speaking the English language
• Ability to use considerable judgment and tact in dealing with physicians, visitors, department managers, administrative staff and employees
• Ability to maintain confidentiality of sensitive material
• Must possess good organizational skills and oral/written communication skills
• Must demonstrate knowledge of medical staff and hospital administration functions

Physical Requirements:

• Must be able to communicate both verbally and written with various education and professional levels and backgrounds
• Work is sedentary in nature
• May on occasion require attendance at early morning and late evening meetings