The Medical Staff Specialist (MSP) is responsible for the overall administration of the hospital(s) credentialing requirements for a cadre of physicians and advanced practice providers. This entails the planning and organization of work, ensuring proper storage, formatting and integrity of this information in the enterprise-wide credentialing system, preparation of material for committee approval, workflow and documentation issues, and compliance with the internal policies and procedures. This position requires the utmost confidentiality as the MSP is responsible for ensuring that provider files, as initially compiled by the Central Credentialing Office, are complete with background check on providers include but is not limited to malpractice history, work and education history, and a criminal history record check at a minimum. MSP works with hospital leadership including Chiefs, Chairs and other Medical Staff leaders to ensure that provider files are thoroughly reviewed, "Red Flags are addresses, and applicants/reapplicants are approved by the department leadership and hospital committee(s) including the Board/Trustees.
Principal Duties and Responsibilities
Plan out workload required for all first appointments or reappointments of an assigned group of physicians and advanced practice providers. Make recommendations for changes in departmental procedures to accomplish goals as necessary. Take initiative in identifying problems, in seeking necessary resources or information, and in solving any problems that arise in the credentialing and privileging approval process. Assume responsibility for smooth running of entire committee approval process, meeting deadlines on the completion of an application to the medical or and advanced practice provider staff, or in securing of temporary or emergency privileges for physicians and advanced practice providers as necessary. Provide necessary documentation, as required, to Central Credentialing Office and/or affiliated hospitals for cross-credentialing.
Work with CCO and clinical Departments to verify list of providers for upcoming reappointment. Review files compiled by CCO including status of "red flagged" providers, follow up on complex red flags that are unable to be addressed by CCO. This may include detailed discussion of issues directly with providers and collection of confidential documentation as required for hospital committee processes. Present all findings to Chief/Chair or designee.
Ensure that all information is maintained in confidential, secure environment at all times, including the storage of information collected in the enterprise-wide credentialing system.
Interprets material received from CCO in terms of timeliness and thoroughness of completion. Contact CCO, individual physicians or advanced practice providers, or division representatives, for missing information. Ensure malpractice coverage for provider is appropriate for privileges requested. Review entity specific malpractice reports monthly for accuracy and reconcile year-end report with departments.
Adhere to strict guidelines as established to assure TJC, CMS, state/federal regulations, URAC, and NCQA compliance. Participate in and prepare files for audits conducted by the agencies to measure the Hospitals compliance rate.
Represent hospitals to department/division chiefs, outside agencies (e.g., Risk Management Foundation for malpractice information, third party payers, State licensing agencies), or other hospitals. Gather necessary information regarding physicians and advanced practice providers in order to comply with hospitals' policies or to resolve policy or procedure questions between the hospitals and these outside groups. Work closely with the Regional Director regarding any questions or problems concerning general credentialing policy issues, or regarding any specific issues concerning an application for appointment or reappointment or enrollment or re-enrollment.
Prepare and present completed packets of material for department level credentials review on a regular basis as applicable by entities. Meet with departmental leadership, credentials committees, and/or other applicable committees to discuss applications. Act as administrative representative and resource to committee members and hospital leadership. After an appointment decision is reached, update existing records to reflect new status and coordinated approval by hospital committees. Store all applicable documentation, as necessary, for on-going reference.
Advise and direct appropriate staff when responding to queries from outside institutions regarding required information mandated by state regulations for both current and past physician and advanced practice provider members for the hospitals. This may involve searching for information in-house, contacting other agencies, physicians or advanced practice providers for missing information. The MSP also acts as the liaison to the physician's or advanced practice provider's respective department/division chief for completion of certain material (e.g., the physician's/APP's ability to handle clinical assignments).
Provide resource information to department staff, divisional representatives, or individual physicians and advanced practice providers as necessary, using database source. Need to keep current regarding any changes in hospitals policies, NCQA, TJC and Massachusetts state regulations. Recommend changes in existing hospital policies or procedures as necessary to comply with changes.
Work with CCO leadership and Business Analysts to obtain required reports to monitor compliance with regulations, such as status reports of the completeness of files on any individual physician or advanced practice provider at any given date, total number of physicians and advanced practice providers in an identified group already credentialed or to be credentialed, etc. Provide detailed plan of accomplishing goal of meeting hospital and regulatory deadlines for first appointments or reappointments and insurance enrollment or re-enrollment on an on-going basis, anticipating workload, and acknowledging any contingencies.
Use/s the Partners HealthCare values to govern decisions, actions and behaviors. These values guide how we get our work done: Patients, Affordability, Accountability & Service Commitment, Decisiveness, Innovation & Thoughtful Risk; and how we treat each other: Diversity & Inclusion, Integrity & Respect, Learning, Continuous Improvement & Personal Growth, Teamwork & Collaboration
Other duties as assigned
Bachelor's Degree in Healthcare or a management related field. Graduate degree, MHA/MBA/MS in hospital administration, healthcare administration, or specialty field a plus.
3-5 years experience in Credentialing, Privileging, or related field including experience in a management capacity
A combination of education and experience may be substituted for requirements
Skills, Abilities and Competencies Required
Very strong organization skills required to keep a very large and complex system running efficiently.
Ability to assume the overall responsibility in the management of a time-sensitive and important part of an individual's appointment to the medical or advanced practice provider staff.
Strong analytical skills and ability to identify problems as they arise in the credentialing process and strong problem-solving skills needed to resolve any problem as they arise
Independent decision-making skills are vital since the minimal amount of supervision that the individual will receive necessitates an ability to act independently using sound judgment.
Good negotiating skills dealing with the time-sensitive information needs and physicians, advanced practice providers, outside institutions, etc.
Must be able to maintain and keep confidential sensitive information.
Must be able to work and maintain data within multiple, integrated computer systems.
Possess strong interpersonal skills to effectively communicate with cross functional teams including staff at all levels of the organization
Ability to successfully negotiate and collaborate with others of different skill sets, backgrounds an levels within and external to the organization
Strong problem solving and negotiation skills
Ability to effectively conduct meetings, both formal and informal
Requires minimal direction from leadership and possesses the ability to learn quickly
Possible local travel to Partners sites
Partners Healthcare System