Medical Staff Specialist

Trinity Health•Livonia, MI

30d•Onsite

About The Position

Under general supervision, coordinates and supports the Credentialing Department functions. Leads and coordinates processes necessary to provide compliant credentialing and privileging services. Provides reports and other information to Trinity Health Livonia (THLA) committees, Boards of Directors, and other customers. Administers the Credentialing Policy and Procedures and services for THLA and contacted groups to ensure compliance with applicable rules and regulations. Coordinates projects to improve the quality and efficiency of the credentialing and privileging process. ESSENTIAL FUNCTIONS AND RESPONSIBILITIES This position is on-site in Livonia Assists with the development and ongoing maintenance of the Credentialing department policies and procedure manual. Develops reports and metrics to assist with ongoing monitoring of credentialing activities and productivity standards. Provides back up support to Credentialing Department leadership for all accreditation surveys. Coordinates the credentialing/recredentialing process, including initializing the process, monitoring, follow-up on required documents, regular reporting of status of initial credentialing/reappointment to Department Chairs and Credentials Committee. Screens application requests in advance of application launch to identify any potential controversial issues or concerns. Completes final review of recredentialing applications prior to Committee presentation to ensure complete and accurate files. Supports Credentials Committee, Medical Executive Committee, and/or Local Board meetings, which may include coordinating presentations, agenda development, preparation of meeting materials, taking meeting minutes, and follow up on committee initiatives. Maintains and updates confidential physician files. Maintains MSOW database and ensures mailing addresses, telephone numbers, participation in various managed care organizations, and other key demographics are up to date and accurate. Responds appropriately to time-sensitive requests. Monitors compliance with applicable rules, regulations, standards, state, and federal law. Offers assistance and support to Credentialing Department leadership. Fields telephone calls and monitors shared email inbox regarding managed care products, application requests, credentialing/recredentialing procedures, etc. Maintains primary contact between the clinical Departments and the Committees. Participates in professional development programs and professional organization to grow in understanding of various regulations and legislation of health care industry as appropriate. Maintains good rapport and cooperative relationships. Approaches conflict in a constructive manner. Helps identify problems, offer solutions, and participates in their resolution. Maintains the confidentiality of information acquired pertaining to patient, physicians, employees, and visitors to THLA. Discusses patient and hospital information only among appropriate personnel in appropriately private places. Behaves in accordance with the Mission, Vision, and Values of Trinity Health. Assumes responsibility for performance of job duties in the safest possible manner, to assure personal safety and that of coworkers, and to report all preventable hazards and unsafe practices immediately to management.

Requirements

Associate degree (health care, office, or business administration or related field) OR equivalent combination of education and experience.
Minimum three (3) years of administrative experience, preferably credentialing experience, in a hospital setting or medical staff office.
Proficient in the use of credentialing software systems with specific skills in using MSOW processes and the MSOW Administrative Review Module (ARM) preferred.
Fundamental knowledge of the Centers for Medicare and Medicaid (CMS), The Joint Commission (TJC), and National Commission for Quality Assurance (NCQA) rules and regulations that govern credentialing and privileging preferred.
Ability to work independently with minimal supervision.
Strong communication skills including the ability to correspond effectively, as well as verbally convey information clearly, listen actively, and consider varying viewpoints when making decisions.
General understanding of the current health care environment, including familiarity with managed care concepts and integrated delivery systems.
Strong organizational skills and the ability to provide attention to detail and complete work in a thorough manner.

Nice To Haves

Bachelor’s degree preferred.
Experience working with a corporate or contracted credentials verification office (CVO) preferred.
Certified Professional Credentialing Specialist (CPCS) certification preferred.
Proficient in the use of credentialing software systems with specific skills in using MSOW processes and the MSOW Administrative Review Module (ARM) preferred.
Fundamental knowledge of the Centers for Medicare and Medicaid (CMS), The Joint Commission (TJC), and National Commission for Quality Assurance (NCQA) rules and regulations that govern credentialing and privileging preferred.

Responsibilities

Assists with the development and ongoing maintenance of the Credentialing department policies and procedure manual.
Develops reports and metrics to assist with ongoing monitoring of credentialing activities and productivity standards.
Provides back up support to Credentialing Department leadership for all accreditation surveys.
Coordinates the credentialing/recredentialing process, including initializing the process, monitoring, follow-up on required documents, regular reporting of status of initial credentialing/reappointment to Department Chairs and Credentials Committee.
Screens application requests in advance of application launch to identify any potential controversial issues or concerns.
Completes final review of recredentialing applications prior to Committee presentation to ensure complete and accurate files.
Supports Credentials Committee, Medical Executive Committee, and/or Local Board meetings, which may include coordinating presentations, agenda development, preparation of meeting materials, taking meeting minutes, and follow up on committee initiatives.
Maintains and updates confidential physician files.
Maintains MSOW database and ensures mailing addresses, telephone numbers, participation in various managed care organizations, and other key demographics are up to date and accurate.
Responds appropriately to time-sensitive requests.
Monitors compliance with applicable rules, regulations, standards, state, and federal law.
Offers assistance and support to Credentialing Department leadership.
Fields telephone calls and monitors shared email inbox regarding managed care products, application requests, credentialing/recredentialing procedures, etc.
Maintains primary contact between the clinical Departments and the Committees.
Participates in professional development programs and professional organization to grow in understanding of various regulations and legislation of health care industry as appropriate.
Maintains good rapport and cooperative relationships.
Approaches conflict in a constructive manner.
Helps identify problems, offer solutions, and participates in their resolution.
Maintains the confidentiality of information acquired pertaining to patient, physicians, employees, and visitors to THLA.
Discusses patient and hospital information only among appropriate personnel in appropriately private places.
Behaves in accordance with the Mission, Vision, and Values of Trinity Health.
Assumes responsibility for performance of job duties in the safest possible manner, to assure personal safety and that of coworkers, and to report all preventable hazards and unsafe practices immediately to management.