Corp Dir, Medical Staff Srvc

Description

The Corporate Director of Medical Staff Services is responsible for the leadership, management, and administration of centralized credentialing, government and managed care enrollment and medical staff support at Emory Healthcare. This role involves ensuring compliance with Joint Commission, Centers for Medicare and Medicaid Services, National Committee for Quality Assurance, Georgia Department of Community Health and other applicable regulatory requirements. The Corporate Director effectively collaborates with senior executives, medical staff leaders, physicians, administration, and other departments to maintain the quality and efficiency of credentialing and enrollment operations and support the medical staff in delivering exceptional quality healthcare services.

 

1. Leadership and Management:

• Develop and implement strategic plans for medical staff services in alignment with the organizational goals and regulatory standards
• Serve as Emory Healthcares resident expert on credentialing, enrollment and medical staff issues
• Provide strategic direction and oversight for the Medical Staff Services department
• Lead and mentor staff to promote a culture of professionalism, teamwork, and excellence

2. Operational Oversight:

• Oversee the credentialing, privileging, appointment and Medical Staff Office support for medical staff members, Advanced Practiced Providers, and Allied Health professionals, ensuring adherence to accreditation standards and regulatory requirements while delivering excellent customer service
• Oversee the Centralized Verification Office (CVO) and the accurate, efficient and provider friendly processing of applications in accordance with accreditation and regulatory standards
• Oversee the Government and Managed Care Enrollment teams to ensure provider and facility enrollment is completed in a timely and efficient manner, avoiding the loss of revenue and delays in Emory Healthcares revenue cycle
• Set performance goals, monitor workflows and measure team member performance, determining appropriate improvement measures when needed
• Oversee Emory Healthcares Delegated Credentialing program, ensuring compliance with contract standards and performance under the agreements
• Maintain accurate and current records of provider qualifications, licenses, and certifications
• Chair, facilitate and support meetings, committees, and activities
• Prepare materials in support of department and organizational initiatives

3. Regulatory Compliance:

• Ensure compliance with federal, state, and local regulations as well as accreditation standards (e.g., Joint Commission, NCQA)
• Monitor and interpret changes in healthcare regulations impacting credentialing, medical staff and enrollment operations
• Prepare and submit necessary documentation for regulatory agencies and support Emory Hospitals, The Emory Clinic and Emory Ambulatory Surgery Centers in accreditation surveys

4. Collaboration:

• Collaborate with EHC Board members, Hospitals Chief Quality Officers, Chief Medical Officers, and Chief Operating Officers, Emory School of Medicine Department Chairs, Emory Office of General Counsel, Revenue Cycle leaders and others to address concerns and resolve credentialing, enrollment and medical staff issues
• Collaborate with Emory Healthcare Contracting and Providers Services on the development of Delegated Credentialing Agreements
• Foster strong relationships between medical staff and hospital, clinic and system administration
• Serve as a liaison between physicians and management to address concerns and support effective communication
• Collaborate with other departments to enhance patient care services

5. Quality Assurance:

• Collaborate with medical staff leaders to monitor the quality of care provided by medical staff
• Review policies and procedures to ensure they support Joint Commission and NCQA requirements
• Seek innovative ways to improve the accuracy of the credentialing, privileging, enrollment and medical staff appointment processes through continued standardization and adoption of new processes and technology, processes

6. Policy Development: 

• Review, and update Medical Staff Bylaws and related Governance Documents, policies, and procedures for all Emory Hospitals
• Review and updated the Emory Healthcare Managed Care Delegated Credentialing Plan
• Ensure policies reflect best practices and comply with legal and regulatory requirements

7. Data Management:

• Oversee the maintenance of databases related to medical staff and en