Position Title:
Administrative Director of Medical Staff Services
Department:
Medical Staff/Credentialing
Job Description:
General Description:
The Administrative Director of Medical Staff Services is responsible for the development, strategy, and ongoing efficiency of the Medical Staff Services Department at OU Health. Provides leadership support and oversight for improving and standardizing Medical Staff Services and provider enrollment processes across the OU Health enterprise. Oversees the medical staff credentialing and privileging processes, including initial/recredentialing and appointment/reappointment processes for physicians and advance practice professionals (APPs) pursuant to the medical staff bylaws, rules and regulations, and policies (“MS governing documents”), including delegated credentialing processes and policies for OU Health Partners. Ensures compliance is maintained with MS governing documents, health plan delegation agreements, applicable accreditation standards: The Joint Commission (TJC), National Committee on Quality Assurance (NCQA), federal and state laws and regulations, including CMS. Serves as a liaison and resource for physicians, staff, key stake holders and external agencies.
Essential Responsibilities:
Responsibilities listed in this section are core to the position. Inability to perform these responsibilities with or without an accommodation may result in disqualification from the position.
- Ensure timely and efficient processes for credentialing/recredentialing and appointment/reappointment of physicians and APPs and for delegated credentialing, application management and primary source verification, meeting the needs of entities within OU Health requiring credentialing.
- Responsible for the administration and medico-legal aspects of the medical staff organization and serves as an essential link between senior management and the medical staff, and other pertinent stakeholders to promote and enhance good communications and a positive working relationship.
- Maintains a working knowledge of the MS governing documents, accreditation standards, (TJC, NCQA) and applicable state and federal laws, (CMS) and keeps the medical staff updated on all changes.
- Collaborates with physicians, executive and administrative staff to ensure compliance at the highest level with the applicable accrediting (The Joint Commission and National Committee for Quality Assurance) and regulatory agencies regarding medical staff credentialing and delegated credentialing requirements.
- Collaborates with revenue cycle, contracting, IT Security, legal, regulatory, professional liability, human resources, and quality to ensure successful and timely onboarding and credentialing/privileging on the front end through provider enrollment reporting processes to ensure timely and successful commencement of claims filing.
- Responsible for establishing, contributing to, and maintaining continuity in the planning, development and implementation of standards and documents applicable to the medical staff organization and delegated credentialing.
- Reviews and confirms acceptance of all pre-delegation agreements, ensuring compliance with regulatory standards and ability to meet the payer’s expectations related to delegated credentialing – routine reporting, oversight reviews, ongoing monitoring, etc. Remain current on federal CMS enrollment requirements and maintain up-to-date authorized official and practice locations on group contracts.
- Responsible for coordination of OU College of Medicine’s Resident Council, providing administrative support and leadership to assist residents in developing a working relationship with OU Health. Acts as a liaison between residents, senior administration and medical staff to address issues appropriately.
- Responsible for the department’s goals, key performance indicators (KPIs), objectives, budget creation, and compliance.
- Be responsive to health plan inquiries regarding provider status, access, and directories.
- Leads, develops, coaches, and effectively manages the MSSD team to ensure deliverables and performance metrics are met. Works collaboratively with the Manager of the department to develop the team to accomplish results through training, performance management, and recognition. Supports continuing education of MSSD team.
- Leads cross-functional project teams to effectively create and implement medical staff services process improvements.
- Understands the strategic opportunities and challenges faced by the organization in improving the value of credentialing activities as well as other activities in the Medical Staff Services Department.
- Is a champion for process improvement and is able to lead a team through change and ensure that the capabilities are in place for the team to effectively adapt to changing workflow and processes.
General Responsibilities:
Performs other duties as assigned.
Minimum Qualifications:
Education: Bachelor’s degree in related field of study. Master’s degree preferred.
Experience: 6+ years professional work experience, including at least 3 or more years in credentialing management in a supervisory, lead, or project management role. TJC organizational experience preferred. Knowledge of NCQA and TJC ambulatory standards preferred.
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:
- Detailed working knowledge of the hospital and health care industry, and credentialing requirements for medical staff and payers.
- Detailed working knowledge of medical/legal issues and laws, regulatory agencies and other national standards for medical staff and delegated credentialing is required.
- Strong organizational skills which include ability to prioritize tasks based on changing requirements.
- Experience supervising staff, guiding staff toward desired outcome, setting high performance standards and delivering quality services.
- Ability to clearly articulate understanding of policies, procedures and processes.
- Able to establish and maintain effective customer relationships while building trust and respect.
- Excellent verbal and written communication skills, presentation and facilitation skills
- Strong interpersonal and communication skills with the ability to interact with individuals at all levels of the system, including physicians, APPs, executives, and managers.
- Utilize discretion and good judgment in handling confidential and delicate matters.
- Proven ability to solve complex problems effectively and manage multiple high priority deliverables.
- Demonstrated business acumen.
- Proficient with the use of Microsoft Office tools.
#cb
Current OU Health Employees - Please click HERE to login.
OU Health is an equal opportunity employer. We offer a comprehensive benefits package, including PTO, 401(k), medical and dental plans, and many more. We know that a total benefits and compensation package, designed to meet your specific needs both inside and outside of the work environment, create peace of mind for you and your family.
