GENERAL SUMMARY OF POSITION

Provides day-to-day management of Medical Staff Services department to ensure compliance with medical staff Bylaws, State, Federal, regulatory agencies. Essential involvement in the discussion, recommendations, and action of the Credentials Committee, Medical Executive Committee, and the Quality Safety PA Committee of the Board. Provides support of the medical staff accreditation readiness and survey process as it relates to The Joint Commission and/or National Committee for Quality Assurance, and Department of Health visits. Ensures the credentialing/privileging process complies with organizational as well as an accrediting agency, Federal, and State regulatory standards. Responsible for the audit and compliance of all credentialing files, which includes management of credentialing information, coordination of facility correspondence, and interaction with practitioners and MSH CVO and MedStar Family Choice associates. Responsible for the management of facility-specific data within the credentialing database.

EDUCATION

• Bachelor’s degree in related field required
• One year of relevant education may be substituted for one year of required work experience.

EXPERIENCE

• 3-4 years Experience in credentialing and/or medical staff services management. equivalent experience in areas related to regulatory, quality, risk management and compliance will be also be considered required
• One year of relevant professional-level work experience may be substituted for one year of required education.

KNOWLEDGE, SKILLS, AND ABILITIES

• Proven problem-solving skills and ability to exercise independent judgment.
• Business acumen and leadership skills.
• Strong verbal and written communication skills with the ability to effectively interact with all levels of management, internal departments, and external agencies.
• Working knowledge of various computer software applications.
  This position has a hiring range of $63,793 - $113,318

• Assists in the development of departmental goals, objectives, policies, and procedures. Ensures compliance with business unit policies and procedures and governmental and accreditation regulations.
• Selects, trains, orients, and assigns department staff. Works with Director to develop standards of performance, evaluates performance, and conducts performance management planning. Initiates or makes recommendations for personnel actions. Maintains ongoing communication with subordinates to review programs, provide feedback, discuss new developments, and exchange information.
• Provides input into the development of departmental operating budget and manages resources according to the approved budget.
• Ensures compliance with CMS, TJC, and/or NCQA standards and practitioner credentialing regulations as mandated by State and Federal law.
• Responsible for data entry of facility-specific practitioner data within the credentialing databases. Utilizes appropriate database tracking reports to ensure accuracy and thoroughness of imported data as well as data that may be entered manually.
• Assists with the billing, collection, and deposit of medical staff.
• Coordinates the granting of temporary privileges for medical staff and advanced practice clinicians in accordance with corporate policy and medical staff bylaws.
• Manages the initial and reappointment credentialing process at the facility level. Works in collaboration with the MSH CVO associates for timely receipt and accuracy of credentialing and re-credentialing applications. Tracks initial/re-credentialing applications sent, received, and in-process.
• Responsible for 100% auditing and analyzing all applications for clarity, quality, and completeness of data in accordance with policies and procedures, Joint Commission, NCQA accrediting standards, and state and federal regulatory requirements.
• May process initial/re-credentialing applications for those applications that have been deemed fast-track” applications.
• Processes all applications for modification of privileges.
• Works collaboratively with the Director, AVP, VPMA, legal, and medical staff leadership to develop, revise and implement policies, procedures, and documents related to credentialing, privileging, and medical staff services.
• Assists the Director with the preparation of correspondence and periodic reports on a variety of matters requiring an in-depth understanding of departmental needs and activities for medical staff leadership, hospital leadership, and departmental meetings in matters relating to medical staff services, credentialing, privileging, practitioner professional practice evaluation/quality profiles and primary source verification. Includes the data collection for FPPE/OPPE.
• Actively participates in activities to support the functions of the organized medical staff, including but not limited to the Credentials Committee, Medical Executive Committee, and Medical Staff meetings.
• Maintains competency on nationally recognized medical staff services and credentialing-related initiatives through participation with NAMSS and MAMSS, journal articles, and other industry-related news.
• Maintains competency on the credentialing database via participation in online education learning modules and monthly skills-related webinars.
• Participates in meetings and on committees and represents the department and hospital in community outreach efforts.
• Participates in multi-disciplinary quality and service improvement teams and maintains effective working relationships with other departments.