Medical Staff Services Consultant
About The Position
The Medical Staff Services Consultant will oversee projects and processes pertaining to Medical Staff functions including enrollment, delegation, licensing, credentialing, system performance, etc. This role supports and/or administers all credentialing and other regulatory audits, developing the planning and design, including gap assessments, outcome measurement, and impact of each audit. The consultant will develop training materials and checklists, and systems to meet the requirements of accrediting bodies regarding the credentialing process and performance improvement initiatives. This position serves as a content expert for credentialing, privileging, delegation, licensing, and/or enrollment. The role also involves managing, developing, and maintaining policies and practices to ensure adherence to requirements from state and federal entities such as FCVS, CMS, Joint Commission, NCQA, etc., and reviewing contract amendments to update policies and procedures accordingly. Additionally, the consultant will oversee, maintain, and troubleshoot software systems (e.g., Cactus, Verity) and their interfaces with other systems (e.g., EPIC), ensuring the quality, efficiency, and data integrity of information flow. This includes partnering with stakeholders like division leaders, Revenue Cycle Management, IT, and Planning and Business Development for system and data requests. The role requires partnering and communicating with key internal and external stakeholders, including vendors and collaborative institutions, to build strong relationships between Medical Staff Services and partners such as providers, internal revenue cycle, divisions, government entities, State Medical Boards, MCOs, and Commercial contracts representatives. Developing, maintaining, and monitoring reporting systems for various divisions/departments is also a key responsibility. Finally, the consultant will develop and seek opportunities to improve Medical Staff processes (e.g., application process, licensing, credentialing, enrollment, reporting), serve as a project consultant for quality improvement projects, and oversee/assist with data collection, management, and reporting, finding innovative ways to improve efficiency.
Requirements
- Bachelor's degree in a related field or equivalent combination of education and experience
- 2+ years of work experience in a related job discipline.
- Certified Professional Credentialing Specialist OR Certified Professional Medical Staff Management (CPMSM)
Responsibilities
- Oversee projects and processes pertaining to Medical Staff functions including enrollment, delegation, licensing, credentialing, system performance, etc.
- Support and/or administer all credentialing and other regulatory audits.
- Develop the planning and design, to include a gap assessment, outcome measurement, and impact of each audit.
- Develop training materials and checklists.
- Develop systems to meet the requirements of accrediting bodies in regards to the credentialing process and performance improvement initiatives.
- Serve as a content expert for credentialing, privileging, delegation, licensing and/or enrollment.
- Manage, develop and maintain policies and practices to ensure adherence to requirements from state and federal entities such as FCVS, CMS, Joint Commission, NCQA, etc.
- Review contract amendments and update policies and procedures accordingly.
- Oversee, maintain and trouble-shoot software system (i.e. Cactus, Verity) as well as the interface with other systems (i.e. EPIC).
- Oversee the flow of information from intake to final output, to ensure quality, efficiency and data integrity.
- Partner with stakeholders such as division leaders, Revenue Cycle Management, IT, and Planning and Business Development, and others, in response to system and data requests.
- Partner and communicate with key internal and external stakeholders, including vendors, collaborative institutions, etc.
- Build strong relationships between Medical Staff Services and internal and external partners such as providers, internal revenue cycle, divisions, government entities, State Medical Boards, MCOs and Commercial contracts representatives.
- Develop, maintain and monitor reporting systems to be shared with various divisions/departments.
- Develop and seek opportunities to improve Medical Staff processes (i.e. application process, licensing, credentialing, enrollment, reporting, etc.).
- Serve as a project consultant for quality improvement projects.
- Oversee and/or assist with data collection, management and reporting of data.
- Find innovative ways to improve efficiency of various tasks and processes.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
