Medical Staff Specialist

Description

JOB SUMMARY

Under the general direction of the Chief of Revenue Cycle and Compliance, the Medical Staff Specialist provides coordination and administrative support while performing confidential, and time-sensitive functions of medical staff services. The Medical Staff Specialist will be responsible for managing all aspects of medical credentialing and privileging processes, ensuring compliance with regulatory requirements, facilitating effective communication between medical staff members and clinicians, administration, and other relevant departments, coordinating and managing meetings for medical staff services, as well as peer review monitoring and tracking.

STANDARDS OF PERFORMANCE

Communication, Collaboration and Confidentiality:

• Serve as the primary point of contact for medical staff practitioners regarding credentialing, privileging, meeting coordination inquiries and issues.
• Respond to email communications professionally and timely.
• Collaborate with department chairs, medical directors, chiefs, administration, practitioners, and other departments within the organization to ensure effective communication and coordination of activities. 
• Maintain confidentiality of sensitive medical staff information and adhere to HIPAA regulations. 

Compliance Regulatory Monitoring and Requirements:

• Ensure compliance with state, federal, and accrediting agency regulations regarding medical staff credentialing and privileges.
• Maintain comprehensive knowledge of relevant regulations, accreditation standards, and implement necessary updates and changes as required.
• Monitor compliance with established policies, processes and procedures, and bylaws through regular audits, assessments, and evaluations.
• Review and revise existing policies, procedures, and processes annually and as needed.

Credentialing and Privileging:

• Oversee the entire credentialing process for all medical staff members and clinicians, including physicians, advanced practice practitioners, and allied health professionals.
• Process credentialing applications and Board approvals, complete appropriate checklists, and follow-up on pertinent documentation and requests.
• Verify and maintain accurate and up-to-date documentation, including licensure, certifications, malpractice insurance, education, training credentials, peer references, and hospital affiliations.
• Perform background checks, primary source verifications, and evaluation of malpractice claims.
• Coordinate the privileging process, including reviewing and approving clinical privileges based on qualifications and scope of practice.

Database Management:

• Utilize credentialing software to manage electronic files and track credentialing and privileged activities.
• Generate reports and analyze data related to medical staff credentialing and privilege processes. 
• Maintain accurate and up-to-date credentialing files for all medical staff members and clinicians, ensuring compliance with regulatory standards and hospital policies. 

Meeting Coordination:

• Coordinate meetings related to medical staff services, including conference room reservations, scheduling, and meeting reminders; place catering orders; prepare agendas and packets; record and complete meeting minutes and PowerPoint presentations; and follow up on action items.
• Ensure timely distribution of meeting materials and follow-up on action items.

Peer Review Monitoring and Tracking:

• Assist in the monitoring and tracking of peer review activities, including case reviews, quality improvement initiatives, and peer evaluation processes.
• Maintain confidentiality and integrity in handling peer review information.

Quality Improvement:

• Participate in quality improvement initiatives and meetings related to medical staff credentialing, privileges, and peer review processes.
• Identify opportunities for process improvement and implement strategies to enhance efficiency and accuracy. 

Requirements

Minimum Level of Education: High School Diploma required. Bachelor's degree in healthcare administration, business administration, or related field preferred.

Formal Training: Strong organizational skills, critical thinking and attention to detail, and analytical skills. Knowledge of medical staff credentialing processes, including CMS, Joint Commission, and state regulatory requirements. Excellent communication and interpersonal skills, with the ability to interact effectively with medical staff members, administrators, and external agencies. <