Manager, Credentialing - Medical Staff Services

NYU Langone Medical Center•New York, NY

47d

About The Position

We have an exciting opportunity to join our team as a Manager, Credentialing - Medical Staff Services. In this role, the successful candidate The MSS Manager for quality and audit is responsible for audit of files for monthly credentials committee and ongoing file reviews before delegated audits, regulatory audits and surveys and OPMC and other file requests. This position audits the credentialing verification process on physicians/dentists and allied health practitioners in accordance with regulatory and accreditation requirements. This position manages the regulatory compliance function of the Medical Staff Services offices to assure departmental achievement of compliant documentation with multiple requirements including monthly sanction screens, monitoring of OIG, Opt-Outs, exclusions, expireables, etc. and advisory alerts from OPMC. This position also manages the provider regulatory training requirements and required learning to assure departmental achievement of compliant documentation with multiple physician requirements.

Requirements

Bachelor's Degree and NAMSS certification
minimum of five years of progressive responsible experience in an administrative role, or an equivalent combination of education and experience
Experience with credentialing management system (i.e. sProvider, CAQH, etc.)
Excellent verbal and written communication skills
Self-motivated with the ability to complete projects independently within established timeframes
Ability to handle multiple projects and deadlines
Must be well organized and able to prioritize responsibilities

Nice To Haves

Master's Degree
Working knowledge of Provider credentialing database
Able to demonstrate good independent judgment and strong interpersonal relationship skills in working with direct employees, medical staff leaders and other Departments in the NYU Health system.

Responsibilities

Maintains knowledge of standards of the Joint Commission on Accreditation of Healthcare Organizations, National Committee for Quality Assurance and State and Federal regulations related to Medical Staff organization.
Maintains working knowledge of the Medical Staff Bylaws, Rules and Regulations, and Hospital policies, and works to ensure the medical staffs compliance within the stated parameters.
Prepares for regulatory survey for the medical staff/leadership function, including staff and medical staff education regarding accreditation standards.
Participates in onsite surveys by TJC, CMS, NYS DOH, NCQA or other agencies as needed.
Closely monitors information collected by the teams to assure it meets Joint Commission, DOH and other regulatory requirements, evaluates information collected for adequacy and completion, and pursues additional information as necessary. Ensures that quality assurance standards are upheld and conducts continuous audits as a means of oversight.
Responsibility and accountability for auditing the application process for the appointment and clinical privileging of physicians and other health care practitioners.
Conducts audits of the sProvider database to assess completeness of information and qualifications relative to established standards, accuracy of data entry and updated information in files.
Manages regulatory training assignments in LMS for all new appointments to the Medical and Dental Staff including orientation and annual education programs. This includes providing individual assistance to practitioners to access required courses in LMS.
Responsible for conducting Information Integrity Training for all credentialing staff members on an annual basis to ensure compliance with NCQA standards for delegated credentialing.
Responsible for conducting the annual audit of provider files credentialed and re-credentialed during the previous year to ensure compliance with NCQA standards for delegated credentialing.
Participates in other Medical Staff functions and projects as necessary.
Assists in setting up office systems for credentialing related matters.
Performs other duties as directed and leadership activities, as assigned.