General Description :

Provides leadership, guidance, and technical support to and oversight of the medical staff services department.

Essential Responsibilities :

Provides oversight of the medical staff credentialing / privileging and appointment / reappointment processes, as well as implementation of applicable policies and procedures, to ensure timely verification and processing of applications.

Leads delegation audits under supervision of department director to ensure compliance with payer delegation contracts.

- Coordinates with quality department to ensure facilitation of both Ongoing Professional Practice Evaluation (OPPE) and Focused Professional Practice Evaluation (FPPE).
- Serves as key liaison or designates department staff members to serve as key liaison to clinical departments and sections regarding the credentialing and appointment processes and development of delineation of privileges forms to ensure that all privileging is a criteria-based system.
- Plans activities of the Medical Staff committees and provides direction and oversight for department personnel supporting such committees and their meetings.
- Serves as a liaison between the medical staff and medical staff services department.
- Plans, organizes, assigns, and oversees the day-to-day operations and facilitates the workflow of the team. Works with staff to monitor processes and procedures and to ensure excellent service to the medical staff as well as other pertinent stakeholders.
- Remains a subject matter expert with the credentialing software.
- Promotes and fosters a collegial relationship with the OU College of Medicine and GME Department and collaborates on work when applicable.
- Ensures equitable distribution of work assignments to the Credentialing Coordinators and Credentialing Lead.
- Improves overall performance in credentialing processes, tools, resources, and outcomes to facilitate the achievement of the organization’s strategic goals.
- Ensures that the credentialing process is high quality by instituting and tracking to KPIs and data metrics for Medical Staff Services.

Provides input to the Director of Medical Staff Services regarding staff performance and KPIs. Works with the Director to implement internal ongoing performance improvement initiatives and implements corrective measures as applicable.

- Ensures that downstream / organization impacts are identified, understood, and communicated to the team. Develops / improves / documents and implements medical staff processes / procedures specific to the credentialing process workflows, from initial launch of an application to notification of the final recommendation by the Board.
- Performs the functions of the Credentialing Coordinator which includes the verification of initial and reappointment applications as well as the maintenance of medical staff databases, as needed.
- Identifies trends or issues, rectifies when appropriate and works with the Director to implement process improvement initiatives.
- Interviews, evaluates, and counsels staff and ensures that new staff members are oriented and trained appropriately.
- Applies traditional management techniques (organizing, planning, directing, controlling) to the organized medical staff structure.

Demonstrates team motivation and fosters professional growth.

- Applies and implements accreditation and regulatory standards. Joint Commission, NCQA, AAAHC and CMS.
- Is knowledgeable of industry-leading practices and implements as appropriate to the situation.

General Responsibilities :

Performs other duties as assigned.

Minimum Qualifications :

Education :

Bachelor’s degree in related field of study

Experience :

At least three (3) years of relevant management experience in credentialing.

License(s) / Certification(s) / Registration(s) Required :

NAMSS certification as a Certified Provider Credentialing Specialist (CPCS) or Certified Professional in Medical Staff Management (CPMSM) or achievement of certification within 18 months of hire.

Knowledge, Skills and Abilities :

- Knowledge of TJC, CMS and NCQA accreditation standards and legal requirements related to medical staff organization.
- Knowledge of relevant laws and regulatory standards. Ability to establish and maintain effective customer relationships.
- Excellent verbal and written communication skills and the ability to communicate with a variety of individuals, including all medical staff members / leaders, employees, and health system leaders.
- Ability to address changing priorities, high volumes and adapt quickly to change and strong project management skills.
- Excellent computer skills.
- Ability to effectively work independently as well as in a team environment.
- Strong team leadership skills.