The Medical Staff Manager, under the supervision of the CMO and Administrative Director of the Medical Group, is responsible for the supervision of all functions related to the credentialing, privileging, bylaws and policy development, compliance and regulatory review support and payor enrollment processes for all Mary Free Bed Locations and programs. This position requires establishing lines of communication between the Medical Staff, Administration, and all Departments of the Hospital to maintain compliance with all regulatory, accrediting, and membership-based organizations, carry out various credentialing processes in relation to physicians and other hospital staff professionals within Mary Free Bed Rehabilitation Hospital, Medical Group, and Orthotics and Prosthetics.
• Focus on Patient Care. A selfless drive to serve and heal connects all MFB employees.
• Clinical Variety and Challenge. An inter-disciplinary approach and a top team of professionals create ever-changing opportunities and activities.
• Family Culture. We offer the stability of a large organization while nurturing the family/team atmosphere of a small organization.
• Trust in Each Other. Each employee knows that his/her co-workers can be trusted to make the right decision for our family, patients, staff and community.
• A Proud Tradition. Years of dedicated, quality service to our patients and community have yielded a reputation that fills our employees with pride.
Essential Job Responsibilities:
- Supervise the credentialing and privileging process of the medical and allied health staff professionals ensuring consistency, accuracy, timely compliance with established medical staff documents, processes, accreditation and regulatory bodies
- Produce monthly company-wide status reports and provide diligent management of Physician information
- Maintain Physician adherence to the Medical Staff Bylaws, Rules and Regulations, and Policies; and, must be current with the regulatory agency requirements
- Ensure credentialing documents follow hospital standards and accrediting agencies
- Responsible for the Provider Enrollment functions ensuring that employed physicians are enrolled into group contracted managed care, and government plans timely and in accordance with their specific guidelines through payer credentialing/re-credentialing process or direct submission
- Collaborate with Medical Staff Leadership to implement and maintain a Performance Evaluations (FPPE) and Ongoing Professional Performance Evaluations (OPPE)
- Completion, submission and follow up of all Medicare, Medicaid, CMO and commercial network participation applications and recredentialing applications including effective dates, provider ID's, NPI, license and DEA information, quarterly CAQH attestation
- Maintain PECOS portal and Medicaid web portal setup and user information, collaborate with multiple departments to onboard providers and disseminate provider information
- Communicate with CBO and insurance representatives to resolve network participation issues
- Closely track each payer’s unique process ensuring that clinical team members are added and removed as appropriate; serving as point of contact regarding payer delay issues; ensuring payment is secured and initiating and updating commercial payer contracts when moving an existing center, opening a new center or exploring new markets
- Maintain an employed physician & practice roster
- Maintain compliance with regulatory and accrediting bodies; Joint Commission, NCQA and HRSA/FTCA credentialing requirements
- Oversee and perform the maintenance of state licensure, DEA licensure, and liability insurance, hospital privileging and health plan enrollment for all clinic providers
- Assist with initial application credentialing during times of high volume
- Maintain compliance with regulatory and accrediting bodies; Joint Commission, NCQA and HRSA/FTCA credentialing requirements
- Oversee and perform the maintenance of state licensure, DEA licensure, and liability insurance, hospital privileging and health plan enrollment for all clinic provider
- Provide team supervision including staff selection, development, mentoring, and performance management
- Engage team members and stakeholders with the Mission, Vision, and Values of Mary Free Bed Rehabilitation Hospital
- Assure appropriate staffing levels and adequate supplies and equipment for all areas of responsibility
- Work with leadership to communicate with referral sources and encourage innovation of processes and growth of programs
- Achieve success by meeting performance indicators, standards, and annual performance targets
- Lead selection, training and performance of staff related to assigned areas of responsibility
- Responsible for assuring all staff maintain proper training related to pertinent skills, competencies, standards of behavior, and compliance
- Conduct systematic performance review of all staff
- Communicate and facilitate rapport with staff that secures a highly engaged team who consistently achieves patient satisfaction score goals
- Leadership Must-Haves will be followed for patient and staff interactions:
- Rounding
- Thank You Notes
- Employee Selection/Peer Interviewing
- Key Words at Key Times
- AIDET® + Promise
- Standards of Behavior
Essential Job Qualifications (Knowledge, Education, and Training Requirements):
- Bachelor’s Degree in a health care related field or equivalent work experience.
- At least 3 years’ experience and working knowledge of regulatory agency requirements and the Medical Staff Bylaws.
- Advanced experience in MS Office Suite products, preferred.
- Possess high knowledge base of health care quality guidelines developed by the National Committee for Quality Assurance.
- Experience with medical and professional credentialing processes, policies and procedures, including delegated credentialing requirements.
- Familiarity with medical billing and claims payment system requirements as related to practitioner enrollment.
- Ability to work quickly and accurately and balance workload against shifting priorities and do so while maintaining a positive outlook and approach.
- Requires exceptional critical thinking skills, sound judgment and the ability to communicate in an articulate and sensitive manner with practitioners, administrators, legal counsel and client credentialing personnel.
- Able to exert up to 10-20 pounds of force occasionally (up to 1/3 of the time
- Able to lift, carry, push, pull, up to 10-20 pounds occasionally
- Able to sit for most of the time but may involve brief periods of time involving walking or standing.
- Able to use keyboard frequently (1/3 to 2/3 of the time)
Preferred Qualifications:
- Current certification by the National Association of Medical Staff Services as CPMSM (Certified Professional Medical Services Management) or CPCS (Certified Provider Credentialing Specialist), or the ability to obtain both certifications within three years.
Mary Free Bed is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, national origin, age, genetic information, veteran status, disability or other legally protected characteristic.
