Responsible for ensuring the medical staff credentialing process is timely, within established parameters and meets all regulatory and legal standards. Responsible for management and implementation of all physician office and credentialing/network enrollment activities utilizing considerable latitude and independent judgement.
Responsible for retention of Providers.
Will orient, train, and supervise assigned staff. Evaluates and disciplines employees and interviews and make recommendations regarding hiring of employees.
Let's Shine. Together.
Our values of Excellence, Empathy, Integrity and Accountability are essential to exceed our customers’ expectations. At Reid, we look for individuals who believe in our core values and demonstrate a genuine desire to make a positive impact to those we serve. We take pride in employing people who show up every day with a commitment to these values along with our mission and vision. We are one team working toward a common goal of providing outstanding customer care and service to our communities. If you have a calling to serve and are looking for meaningful and purposeful work, Reid Health is the place for you.
To lead our communities to well-being, one person at a time. It is not just what we do – it is who we are.
Overview of Responsibilities
• Relates formally and informally to a wide range of people in a variety of positions and levels throughout the organization. Relates with various members of middle management team and management group. May relate to individuals outside the hospital or organization as the demands of the position and functions of the department require. Relates formally and/or informally with physicians, allied health professionals, administrative staff as well as other hospital staff and other external entities, including third party payers and Medicare and Medicaid Contractors
• Supervises Medical Staff Services department personnel. Coordinates assignments to ensure timely and correct job completion, assuring that the workflow is smooth.
• Builds and maintains positive working relationships with co-workers and leaders across the Organization.
• Maintains budgetary compliance by controlling inventory and waste, planning, purchases, limiting staff overtime and striving for overall efficiency in operations. Manages all resources in a prudent manner.
• Approves timecard edits, enters schedules into API and maintains attendance records. Write corrective actions and counsel’s staff regarding attendance issues.
• Thoroughly and effectively orient, train, evaluate, counsel, and retrain employees in proper procedures for assigned duties. Evaluates training programs and directs training efforts. Maintains training records and job training check-off lists for assigned staff.
• Performs both 90 day and annual performance evaluation timely.
• Counsels and/or initiates disciplinary actions in an appropriately fair, consistent, and professional manner. Maintains appropriate documentation of counseling and disciplinary actions.
• Writes and implements assigned portion of the action plans related to employee opinion surveys.
• Actively involved in the interviews and makes recommendations and participates in decisions regarding hiring of new employees.
• Coordinates the medical staff credentialing process and maintains records peer protected maintaining confidentiality for the Medical Staff. This encompasses all new appointments and re-appointment processes, including but not limited to biographical information, committee listings, name/address listings, continuing education information, reappointment listings, office listings, attendance, records, minutes, all reports, activities, and correspondence relating to credentialing functions, i.e., communications with licensure boards, insurance carriers, etc. Assures all elements of background checks are completed with due diligence. Contacts medical staff members to relay information or obtain approval on specific issues timely.
• Is the subject matter expert in medical staff affairs and is responsible for maintaining adherence with state, federal and DNV standards. Will be actively involved in regulatory body and State survey processes if needed. knowledgeable about the state and federal regulations impacting credentialing and peer review; stay up to date on such laws, rules, regulations and best practices.
• Timely completes Medicare, Medicaid Provider Enrollment applications for physicians, other Health Care Providers, and/or practices as required by CMS. Ensures all elements of the application are completed and signed by the provider and authorized official.
• Coordinates and, as applicable, enrolls providers with Managed Care plans, Networks, Third Party Administrators, and any other paying or adjudicating entity requiring the registration or enrollment of our providers as a condition of reimbursement.
• Coordinates timely notification to Reid’s Physician Organization, Reid Physician Association, and other appropriate hospital departments of additions, deletions and any other change to our provider master files so that staff is aware of incoming and outgoing providers.
• Responsible for maintaining the continuity between applicants and active providers within the Physicians Master File. Maintain a current log of all open enrollment applications by provider by payer and sends monthly to appropriate individuals.
• Responsible for obtaining CAQH and NPI numbers for providers who do not have these identifying billing numbers. Obtains state licensures for providers as requested.
• Maintains Credentialing/Network Enrollment Policy & Procedure Manual ensuring that the policies meet legal and regulatory requirements. Assures that the Medical Staff Bylaws are following the Medical and Allied Health Practitioner Chapters for DNV Standards.
• Provides the support in medical staff committee meetings and medical staff conferences, including scheduling meeting place, meeting notice/agendas and advance material, audio visual needs, travel arrangements and refreshments/meals when requested, and prepares minutes for approval and distribution. Participates in Committee discussions and makes recommendations where appropriate.
• Assists the Chief of Staff with communication processes within the medical staff and develops creative methods to effectively communicate information to all members of the medical staff.
• Establishes key partnerships with clinical, operational, and physician leadership throughout the organization by collaboratively and proactively addressing and problem solving any issues, challenges, or barriers in the process.
• Responsible for provider onboarding process, ensures compliance and regulatory requirements for the providers employment and clinical practice are met prior to the start date.
• Implement the strategies, programs for the retention of the providers.
• Performs other duties and responsibilities as assigned.
• Associate Degree or higher degree in business or healthcare related field.
• A minimum of two years Medical Staff credentialing experience required. Must be proficient in the use of Microsoft Office programs including Word, Excel and PowerPoint. Must demonstrate and have the ability to communicate well in both verbal and written form. Must possess the ability to use specialized software programs for credentialing, database management, and document management.
• A minimum of two years management experience in healthcare or related field managing in an office environment preferred.
• Knowledge of DNV accreditation standards preferred
Licensure and Certification
Certification through the National Association of Medical Staff Services (CPCS or CPMSM) required or ability to attain.
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Other InformationEEO Statement: Reid Health is an Equal Opportunity Employer
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