The Dir Medical Staff Services is responsible for managing the overall operations of the Credentialing, Medical Staff Services Teams and/or Networking Teams . Provides oversight of the credentialing, re-credentialing, and delegated credentialing processes to ensure compliance with organizational policies and procedures, Medical Staff Bylaws, Medical Staff Rules & Regulations, credentialing policies, delegation standards, and accrediting body standards (i.e. Joint Commission, NCQA, Centers for Medicare and Medicaid, Texas Department of Insurance, etc.).
ESSENTIAL FUNCTIONS OF THE ROLE
Interacts with Senior leadership and other stakeholders on matters concerning the activities of the credentialing and re-credentialing of medical staff, advanced practice professionals and allied health professionals.
Responsible for hiring, training and managing staff. Provides oversight and direction to staff in accordance with the organization's policies and procedures. Coaches, mentors and develops staff. Delegates responsibilities and provide feedback.
Reviews daily operations, including providing work assignments, continuous problem-solving, and prioritization. Works closely with staff to maximize operational efficiencies.
Serves as the subject matter expert for regulatory requirements, measures and standards as they relate to medical staff services, credentialing, and privileging.
Develops and implements policies, procedures and processes for the department that satisfies the business needs of the organization while adhering to applicable standards, regulations and requirements.
Maintains the department budget by seeking avenues for cost containment for credentialing functions. Responsible for timely submission of check requests for payment of invoices related to credentialing functions, ER call payment, medical director payment, etc.
Develops and maintains reports for both internal and external requirements, as needed. Ensures compliance surrounding maintenance of credentialing database. Develops standardized system of database entry/attributes and trains staff on system utilization.
Plans and develops supporting documentation (agendas, minutes, reports) for appropriate committee and department meetings and others as assigned.
May assist with preparation of hospital emergency room call schedule as well as reconciling applicable call schedules with documentation needed to process ER call payments.
KEY SUCCESS FACTORS
Advanced knowledge of The Joint Commission, (TJC), NCQA, Medical Staff Bylaws, Rules & Regulations, regulatory standards, and internal credentialing policies and procedures.
Advanced experience in hospital medical staff services, health plans, or centralized verification organizations required.
Excellent written and verbal communication skills with the ability to effectively communicate with internal and external customers at various levels.
Able to make operational decisions around how work gets done - quality and productivity standards, measurable goals for employees and project teams, etc.
Able to use broader objectives to determine how best to use resources to meet deadlines and goals.
Able to evaluate and recommend changes to policies, and establish procedures that affect the managed organization.
Basic business knowledge, including but not limited to: annual planning and goal setting, adherence to budgets, employee compensation, compliance and risk management.
Advanced computer skills, including but not limited to: Microsoft office Suite (Word, Excel, Outlook, and PowerPoint), database management, information security, payroll systems, scanning, and email. Echo/Verity experience preferred.
Able to make or approve effective hiring and termination decisions as well as handle day-to-day and complex staff issues (behaviors, quality, etc.).
Excellent organizational skills with the ability to work independently as well as in a team environment.
Ability to effectively organize and prioritize duties to meet deadlines as well as set short or long-term goals and strategies to achieve goals.
Our competitive benefits package includes the following - Immediate eligibility for health and welfare benefits - 401(k) savings plan with dollar-for-dollar match up to 5% - Tuition Reimbursement - PTO accrual beginning Day 1 Note: Benefits may vary based upon position type and/or level
- EDUCATION - Bachelors or Equivalent Exp
- EXPERIENCE - 5 Years of Experience
- CERTIFICATION/LICENSE/REGISTRATION - Cert Prof Medical Services Mgr (CPMSM) or Certified Provider Credentialing Specialist (CPCS)
Baylor Scott & White Health (BSWH) is the largest not-for-profit health care system in Texas and one of the largest in the United States. With a commitment to and a track record of innovation, collaboration, integrity and compassion for the patient, BSWH stands to be one of the nation’s exemplary health care organizations. Our mission is to serve all people by providing personalized health and wellness through exemplary care, education and research as a Christian ministry of healing. Joining our team is not just accepting a job, it’s accepting a calling!