MedStar Health · 2 months ago
Senior Director Provider Credentialing
Columbia, MD
Full-time
Onsite
Director/Executive
10+ years expMedStar Health is a leading healthcare provider, and they are seeking a Senior Director of Provider Credentialing to oversee the credentialing and privileging processes for all healthcare providers. This role is responsible for ensuring compliance with regulatory requirements and managing the credentialing team to maintain high operational efficiency.
Health CareMedical
Responsibilities
Develop and implement strategic plans for the credentialing department to align with the organization's goals while collaborating with senior leadership to develop policies and procedures that support organizational objectives
Lead mentor and manage the credentialing team fostering a culture of excellence and continuous improvement. This includes the management of the Central Verification Office's (CVO) workforce to include interviewing hiring scheduling coaching counseling and evaluating all associates and supporting contractors
Oversee the entire credentialing and privileging process for all healthcare providers ensuring compliance and adherence to all regulatory requirements established by state federal and accrediting body standards including but not limited to those set forth by The Joint Commission NCQA CMS and other relevant bodies
Ensure timely and accurate processing of initial credentialing re-credentialing and privileging applications and maintains up-to-date records and documentation for all credentialed providers
Conduct regular audits of credentialing files and processes to identify and address any deficiencies; implement corrective actions and process improvements as needed to maintain high standards of quality and compliance
Serve as the primary point of contact for internal and external stakeholders regarding credentialing matters by building and maintaining effective relationships with medical staff department heads and external agencies
Facilitate communication and coordination between the credentialing department and other organizational units
Utilize credentialing software and databases to manage provider information and ensure data integrity; identify opportunities to audit these databases to ensure data integrity
Develop requirements for the data and analytics strategy to drive continuous improvement throughout CVO operations and support data-driven decision-making; provide insights and recommendations to senior leadership based on data analysis and industry trends
Responsible for all aspects of managing the program-of-record credentialing database (e.g. CredentialStream) including vendor coordination granting user access ensuring associates use the database and supporting MedStar Health leaders requesting system interface to feed related systems (e.g. physician billing services)
Serves as the liaison for physician referral functions provider directory website and all related databases utilizing the specified program-of-record database as the single-source of truth for provider information
In conjunction with MSO leadership provides support to Peer Review Committees as required including but not limited to researching literature data collection and formal presentation and serving as a subject matter expert for the credential process
Serves as the primary liaison to all MedStar Health entity-level Medical Staff Offices and Vice Presidents of Medical Affairs by providing insight into credentialing services delineation of privileges initiatives and other related activities
In conjunction with managers for credentialing services assists in managing systemwide credentialing committee(s) processes by ensuring submitted files are complete and comply with credentialing standards; serves as a subject matter expert regarding for all physician file reviews
In conjunction with MSO leadership serves as the primary liaison with MedStar Health public affairs and marketing functions to provide accurate data and reports supporting the physician referral directory and physician scheduling programs on MedStar Health and entity websites
Participates in multi-disciplinary quality improvement teams and represents the CVO department in entity-level and community outreach efforts
Qualification
Required
Bachelor's degree In healthcare hospital administration or related field required
10+ years Progressive experience managing and leading medical staff functions for a large academic medical center or health system including direct oversight of medical staff credentialing required
10+ years Demonstrated experience in credentialing privileging physician performance/peer review process and working with physician leaders required
10+ years Strong experience in regulatory compliance as it relates to the organized medical staff required
CPMSM - Certified Professional Medical Services Management Upon Hire required
NAMSS-National Association of Medical Staff Services Upon Hire required
Certified Credentialing Provider Specialist Upon Hire required
Excellent verbal and written communication skills
Proficient computer skills and working knowledge of business tools such as Microsoft office or like products
Demonstrated knowledge of the business of healthcare
Demonstrated knowledge of federal and state regulations and standards for the provision of professional education of healthcare providers
Exemplary and timely customer service approach in communicating with internal and external stakeholders
Skilled problem solver with ability to quickly adapt to changing priorities workloads and timelines
Excellent organizational and prioritization skills; rigorous attention to detail
Ability to manage multiple projects and adhere to strict deadlines independently and/or on a team
Dedicated to continuous improvement and quality assurance processes
Self-directed self-motivated team player critical thinker; experienced at effectively participating as part of a team
Preferred
Master's degree In healthcare hospital administration or related field preferred
Company
MedStar Health
MedStar Health is a not-for-profit healthcare organization
10001+ employees
Funding
Current Stage
Late StageTotal Funding
$29MKey Investors
American Medical AssociationAgency for Healthcare Research and QualityA. James and Alice B. Clark Foundation
2023-06-21Grant
2022-09-27Grant· $2M
2020-07-03Grant· $27M
Leadership Team
David Mayer
Executive Director MedStar Institute for Quality and Safety Quality and Safety CEO Patient Safety Mo
Recent News
2025-12-17
Maryland Daily Record
2025-12-05
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