Medical Staff Specialist

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Job Summary

The Medical Staff Specialist (MSP) is responsible for the overall administration of the hospital(s) credentialing requirements for a cadre of physicians and advanced practice providers. This entails the planning and organization of work ensuring proper storage formatting and integrity of this information in the enterprise-wide credentialing system preparation of material for committee approval workflow and documentation issues and compliance with the internal policies and procedures.

This position requires the utmost confidentiality as the MSP is responsible for ensuring that provider files as initially compiled by the Central Credentialing Office are complete with background check on providers include but is not limited to malpractice history work and education history and a criminal history record check at a minimum. MSP works with hospital leadership including Chiefs Chairs and other Medical Staff leaders to ensure that provider files are thoroughly reviewed Red Flags are addresses and applicants/reapplicants are approved by the department leadership and hospital committee(s) including the Board/Trustees.

Principal Duties and Responsibilities

Plan out workload required for all first appointments or reappointments of an assigned group of physicians and advanced practice providers. Make recommendations for changes in departmental procedures to accomplish goals as necessary. Take initiative in identifying problems in seeking necessary resources or information and in solving any problems that arise in the credentialing and privileging approval process. Assume responsibility for smooth running of entire committee approval process meeting deadlines on the completion of an application to the medical or and advanced practice provider staff or in securing of temporary or emergency privileges for physicians and advanced practice providers as necessary. Provide necessary documentation as required to Central Credentialing Office and/or affiliated hospitals for cross-credentialing.

Work with CCO and clinical Departments to verify list of providers for upcoming reappointment. Review files compiled by CCO including status of red flagged providers follow up on complex red flags that are unable to be addressed by CCO. This may include detailed discussion of issues directly with providers and collection of confidential documentation as required for hospital committee processes. Present all findings to Chief/Chair or designee.

Ensure that all information is maintained in confidential secure environment at all times including the storage of information collected in the enterprise-wide credentialing system.

Interprets material received from CCO in terms of timeliness and thoroughness of completion. Contact CCO individual physicians or advanced practice providers or division representatives for missing information. Ensure malpractice coverage for provider is appropriate for privileges requested. Review entity specific malpractice reports monthly for accuracy and reconcile year-end report with departments.

Adhere to strict guidelines as established to assure TJC CMS state/federal regulations URAC and NCQA compliance. Participate in and prepare files for audits conducted by the agencies to measure the Hospitals compliance rate.

Represent hospitals to department/division chiefs outside agencies (e.g. Risk Management Foundation for malpractice information third party payers State licensing agencies) or other hospitals. Gather necessary information regarding physicians and advanced practice providers in order to comply with hospitals policies or to resolve policy or procedure questions between the hospitals and these outside groups. Work closely with the Regional Director regarding any questions or problems concerning general credentialing policy issues or regarding any specific issues concerning an application for appointment or reappointment or enrollment or re-enrollment.

Prepare and present completed packets of material for department level credentials review on a regular basis as applicable by entities. Meet with departmental leadership credentials committees and/or other applicable committees to discuss applications. Act as administrative representative and resource to committee members and hospital leadership. After an appointment decision is reached update existing records to reflect new status and coordinated approval by hospital committees. Store all applicable documentation as necessary for on-going reference.

Advise and direct appropriate staff when responding to queries from outside institutions regarding required information mandated by state regulations for both current and past physician and advanced practice provider members for the hospitals. This may involve searching for information in-house contacting other agencies physicians or advanced practice providers for missing information. The MSP also acts as the liaison to the physicians or advanced practice providers respective department/division chief for completion of certain material (e.g. the physicians/APPs ability to handle clinical assignments).

Provide resource information to department staff divisional representatives or individual physicians and advanced practice providers as necessary using database source. Need to keep current regarding any changes in hospital policies NCQA TJC and Massachusetts state regulations. Recommend changes in existing hospital policies or procedures as necessary to comply with changes.

Work with CCO leadership and Business Analysts to obtain required reports to monitor compliance with regulations such as status reports of the completeness of files on any individual physician or advanced practice provider at any given date total number of physicians and advanced practice providers in an identified group already credentialed or to be credentialed etc. Provide detailed plan of accomplishing goal of meeting hospital and regulatory deadlines for first appointments or reappointments and insurance enrollment or re-enrollment on an on-going basis anticipating workload and acknowledging any contingencies.

Other duties as assigned

• Bachelors Degree in Healthcare or a management related field. Graduate degree MHA/MBA/MS in hospital administration healthcare administration or specialty field a plus.
• 3-5 years experience in Credentialing Privileging or related field including experience in a management capacity
• A combination of education and experience may be substituted for requirements

Skills Abilities and Competencies Required

• Very strong organization skills required to keep a very large and complex system running efficiently.
• Ability to assume the overall responsibility in the management of a time-sensitive and important part of an individuals appointment to the medical or advanced practice provider staff.
• Strong analytical skills and ability to identify problems as they arise in the credentialing process and strong problem-solving skills needed to resolve any problem as they arise
• Independent decision-making skills are vital since the minimal amount of supervision that the individual will receive necessitates an ability to act independently using sound judgment.
• Good negotiating skills dealing with the time-sensitive information needs and physicians advanced practice providers outside institutions etc.
• Must be able to maintain and keep confidential sensitive information.
• Must be able to work and maintain data within multiple integrated computer systems.
• Possess strong interpersonal skills to effectively communicate with cross functional teams including staff at all levels of the organization
• Ability to successfully negotiate and collaborate with others of different skill sets backgrounds an levels within and external to the organization
• Strong problem solving and negotiation skills
• Ability to effectively conduct meetings both formal and informal
• Requires minimal direction from leadership and possesses the ability to learn quickly
• Possible local travel to Mass General Brigha sites

Remote

399 Revolution Drive

40

Regular

Day (United States of America)

Mass General Brigham Incorporated is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race color religious creed national origin sex age gender identity disability sexual orientation military service genetic information and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process to perform essential job functions and to receive other benefits and privileges of employment. To ensure reasonable accommodation for individuals protected by Section 503 of the Rehabilitation Act of 1973 the Vietnam Veterans Readjustment Act of 1974 and Title I of the Americans with Disabilities Act of 1990 applicants who require accommodation in the job application process may contact Human Resources at .

Mass General Brigham Competency Framework