Provides coordination and operational oversight of the medical staff office and services. In collaboration with administrative and medical staff leaders, organizes, implements, and coordinates programs and activities of the medical staff to assure strategies and goals are met.
Reports directly to the Director Quality and Clinical Risk Management with matrix relationship to the Chief Medical Officer.
Coordinates daily operations of the Medical Staff Services office, maintaining effective and efficient systems;
Ensures the Medical Staff by-laws, rules & regulations and fair hearing documents are current, reflect current practice and are consistent and in compliance with all standards and regulations. and assures medical staff awareness and compliance to each;
Plans, organizes, and maintains a centralized, comprehensive credentialing program for the Medical Staff and Allied Health Practitioners to include initial appointment, annual review, reappointment, proctoring, and privileging in accordance with regulatory, accrediting agency and bylaws requirements, assuring accuracy and providing reports as required/requested;
Works closely with the CMO, Chief Quality Officer, Chief of Staff, appropriate department leaders and the credentials committee in the review/recommendation process, including recommendations adverse to the applicant;
Responsible for all coordination of all Medical Staff meetings, including agendas and minutes;
Provides administrative support to the Medical Staff Officers, and Committee leaders;
Confirms the Medical Staff by-laws, rules & regulations and fair hearing documents are current, reflect current practice, and are consistent with and in compliance with all standards and regulations, and assures medical staff awareness to each;
Coordinates orientation of new Medical Staff and Allied Health Practitioners, Medical Staff department leaders, committee chairs and members, in carrying out their assigned responsibilities;
Maintains financial records of Medical Staff application and reapplication funds;
Facilitates, in cooperation with the Manager Medical Staff Relations, Medical Staff governance of code of conduct issues;
Maintains delineation of privileges for all provider specialties;
Develops, in conjunction with department leaders, credentials committee chair, and administrative leadership, physician privileges of new or evolving clinical practices;
Assists the quality department review of focused and ongoing professional peer evaluation (FPPE, OPPE);
Collaboration with payor credentialing team;
Other duties as assigned
-Bachelor’s degree from an accredited institution/program or other equivalent education in business, medical staff office procedures or related field required.
-Master’s degree preferred.
-Three to five (3 - 5) years of experience in the coordination of Medical Staff Office Operations required.
-Two (2) years of experience in medical staff credentialing.
-Certified Provider Credentialing Specialist (CPCS) or a Certified Professional Medical Services Manager (CPMSM) preferred upon hire or obtain within 2 years of hire and maintained thereafter.
-Impeccable integrity and ethics
-Excellent verbal and writing skills
-Organized with attention to detail and accuracy
-Experience with Windows based software
-Knowledge, as it relates to credentialing/re-credentialing, of:
-State medical board(s)
-Physician and Allied Health Provider licensure data bank
-Drug Enforcement Agency (DEA) regulations
-The Centers for Medicaid and Medicare (CMA) regulations
-The Joint Commission (TJC)
-South Carolina Department of Health and Environmental Control (DHEC) regulations
-Able to work and communicate effectively with all levels of management, physicians, licensed independent practitioners, and employees.
-Previous credentialing experience preferred
-Medical terminology training preferred
-Knowledge of RLDatix/Verge Health credentialing software preferred
-Monday – Friday, day shift. Evening or early morning hours required a few times a month
Physical Requirements: Light Physical Agility Test (PAT) Rating
While performing the duties of this job, the employee is frequently (activity or condition exists from 1/3 to 2/3 of the time) required to stand, sit, and walk; frequently to use hands, fingers; and frequently to talk or hear. The employee must exert up to 15 pounds of force occasionally (activity or condition exists up to 1/3 of the time), and/or up to 5 pounds of force frequently, and/or a negligible amount of force constantly to move objects.
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.
Internal Number: 2021-8742
About Tidelands Health
Tidelands Health is dedicated to keeping the communities we serve healthy and active, inside and outside of the hospital. Ours is a singular commitment: Better health begins here. As the region’s largest health care provider and MUSC Health affiliate, we serve the Carolinas at four hospitals and more than 60 outpatient locations. More than 2,500 employee, physician and volunteer partners are working side by side with our communities to transform the health of our region – promoting wellness, preventing illness, encouraging recovery and restoring health.