Manager of Medical Staff Services

Manager of Medical Staff Services

Under direct supervision from the Chief Nursing Officer and matrix oversight from the VP of Medical Affairs, oversees the day-to-day operations of the OSS Health Medical Staff Office (MSO). Promotes integrity of the department by ensuring compliance with bylaws, rules and regulations established by OSS Health Medical Staff Office and regulatory bodies. Supports the philosophy and goals of OSS Health.

Qualifications and Education :

Qualifications :

Direct experience in the management of Medical Staff Services and Provider Enrollment is required.

Certified Provider Credentialing Specialist (CPCS), Certified Professional Medical Services Management (CPMSM) or Provider Enrollment Specialist Certification (PESC) required or able to obtain within one year of hire.

Education :

Associate's or Baccalaureate degree in Business or Healthcare Administration is preferred.

Essential Duties and Responsibilities :

• Plans, organizes and directs the day-to-day operations of the Medical Staff Office (MSO) including staff supervision, scheduling and providing consultative expertise to members of the department as needed.
• Develops annual operational budgets and provides direction for the allocation of budget.
• Manages the coordination and integration of services within the department as well as with other departments and facilities. Continually analyzes MSO workflows for modification and improvement.
• Management and oversight of the Physician Licensure and Board CME Oversite Program for all OSS Health employed physician specialties.
• Ensures quality control of all Medical Staff Office operations, ensuring timely processing based on all regulatory standards (CMS, DHS, NCQA, and TJC), OSS Health Medical Staff Bylaws and Policies & Procedures.
• Manages the onboarding and off boarding, initial credentialing, re-credentialing, privileging, and provider enrollment operations of OSS Health employed and contracted providers and facility enrollment for all OSS Health locations, including satellite locations and non-OSS Health facilities our providers service, ensuring timely processing based on all regulatory standards, OSS Health Medical Staff Bylaws and Policies & Procedures.
• Complies with all regulatory standards, providing consultative expertise to the Medical Staff Office and Hospital Leadership on options and permissible actions in order to meet those standards.
• Oversees the final review of all Medical Staff applications prior to Committee Presentation, adhering to all standards and OSS Health Bylaws and the Medical Staff Policy & Procedures :
• Notifies the VPMA and President of the Medical Staff of any red flags and / or concerns with clinical practice.
• Presents completed applications to the Credentials and MEC Committee per the Medical Staff Bylaws.
• Maintains the integrity of the provider's electronic credentialing and enrollment files at all times.
• Coordinates Board of Managers Committee, Bylaws Committee, Credentialing Committee, and the Medical Executive Committee.
• Coordinates with the Director of QI / Risk Management the reporting of practitioners to the National Practitioners Data Bank (NPDB) who do not meet professional standards, such as health care-related adverse actions, licensure actions, professional review actions, DEA actions, and exclusions from Medicare, Medicaid or other federal health care programs.
• Oversees, participates in, and maintains current clinical competency evaluations and peer review (FPPE / OPPE) :
• Analyzes and prepares provider performance improvement, quality / competence data in clear, concise, and structured reports.
• Recognizes, investigates, and validates discrepancies and adverse information obtained.
• Coordinates an appropriate evaluation by the President of the Medical Staff of gathered data.
• Communicates findings and / or resulting actions to key stakeholders and the practitioner.
• Acts as a provider enrollment liaison between the finance staff, coding staff, and enrollment specialists in other hospital departments sharing updates / changes in regards to CMS, DHS and Commercial Insurance carriers programs as assigned.
• Acts as liaison between the Medical Staff, nursing staff, and Administration within the parameters established by the VPMA and officers of the Medical Staff as assigned.
• Administrator and Delegated Official of CMS / NPPES (Medicare) and DHS (Medicaid) for OSS Health (providers and facility).
• Administrator of Delegation Contract Oversight reviews and Audits from payers to include collaboration with QI / Risk Director to oversee CMS General Compliance Audits.
• Oversees the Council for Affordable Quality Healthcare (CAQH) database for all OSS Health providers, to include quarterly attestation and re-attestation to ensure eligibility with commercial insurance plans.
• Oversees quarterly OIG Directory Data audits from commercial insurance plans (excel sheets, database entry, paper verifications, etc.).
• Develops and maintains good working relationships with the OSS Health insurance facility and provider representatives to address issues related to facility and provider enrollment applications.
• Maintains professional growth by participating in educational programs and professional organizations.
• Maintains knowledge of current industry standards, TJC regulations, NCQA regulations, trends, practices and developments.
• Provides leadership and direction to the Medical Staff Office, maintaining a work environment that promotes the creative development of ideas and allows all employees reporting to this position to meet or exceed established standards of performance.
• Provides leadership and direction to the Physical Therapy, DME and Home Health enrollment staff informing them of new payer contracts, completion of their enrollment applications and keeping them apprised of NCQA, CMS, DHS, and military contractor rules and regulation changes.
• Performs other duties that contribute to the overall operation of the organization and department.

Supervisory Responsibilities :

Supervises Medical Staff Services Coordinator, Medical Staff Credentialing Specialists and Medical Staff Support Specialists.