System Director-Provider Verification - HS Credentialing Corporate
Job ID: 11861
Purpose of Position and Scope of Responsibility:
Responsible for directing and leading the management, planning and operational administration of the Metro Medical Staff Services (MSS) and System Provider Verifications Services (SPVS) operations. Responsible for providing credentialing verification services to all metro and regional Baptist hospitals, Baptist Health Services Group (BHSG), NEA Baptist Health Services Group (NEA BHSG), Baptist Rehab Hospital and the Baptist Restorative Care Hospital.Responsible for the appointment and reappointment processes for the six Metro hospitals including clinical privileging delineation. Works to achieve and maintain credentialing and medical staff standards according to the Joint Commission (JC), the National Committee for Quality Assurance (NCQA), the Medical Staff Bylaws, Rules & Regulations; applicable Policies & Procedures, and contractual requirements.Responsible for the direct supervision of the metro medical and credentialing verification staff for one shift, eight (8) hours/day, five (5) days/week and is subject to overtime/callback as required.Principal Accountabilities/Responsibilities:
Directs the daily operations of SPVS and Metro Medical Staff Services, while maintaining compliance with applicable accrediting, regulatory and contractual requirements. Includes administering the appointment/reappointment processing for all Metro and Regional hospitals as well as Restorative Care, BHSG, NEA BHSG, and Baptist Rehab Hospital performing required verification and data gathering. Provides leadership in determining optimal solutions to achieve standardization and efficiency.
- Analyzes, formulates, interprets and maintains Medical Staff Bylaws, Rules and Regulations, and Policies for approval by the Medical Executive Committee (MEC) and Governing Board while promoting compliance with accrediting and regulatory agencies. Documents are deployed to the regional facilities as standard templates.
- Assures compliance with requirements designated in the managed care delegated credentialing contracts for BHSG and NEA BHSG.
- Organizes and manages the delineation of privileges process for the medical staff, independent clinical professionals and advanced practice providers to ensure that all individuals meet the standards for granting clinical privileges within the scope of their training, licensure and current competence.
- Directs the administrative business of the Metro Credentials Committee, Bylaws Committee, Provider Wellness Committee, Medical Executive Committee, Metro Peer Review Committee, System Peer Review Council and Joint Conference including documentation for the Metro Board review/approval. Provides oversight for the BHSG Credentials Committee.
- Oversees the administration and integrity of the Cactus credentialing software which is the enterprise provider database. Assures system oversight, training, troubleshooting, report generation and interface with business-critical systems.
- Administers the collection of funds for Metro appointment/reappointment dues and suspension fines assuring deposit in the Medical Staff Fund. Collaborates with Corporate Finance in the reconciliation of the fund balance for management reporting.
- Administers oversight for the assignment of the Baptist Provider Identifier (BPI) for all new and referring providers across the enterprise.
- Directs the persistent verification of all active system providers including monitoring of license, DEA, advanced life support certification, and certificate of insurance. Conducts monthly review of the OIG/GSA database to identify sanctions that could impact reimbursement or result in fines.
- Monitors disciplinary action for all affiliated practitioners. Reports action to leadership for follow-up as appropriate.
- Directs organization and planning for Fair Hearings including document collection and preparation.
- Collaborates with Legal Counsel on System initiative to review/analyze all Hospital governance documents resulting in a standard template for the enterprise. Support leadership in preparing summaries and coordinating Bylaws education/discussions with administration, System physician leaders and Hospital MECs. Includes ongoing review of CMS and JC standards that may require document changes.
- Administer roll-out of the Physician Leadership Training program for Metro and the regional facilities. Coordinate with leadership and the Office of Development and Education on program design, communication, and deployment.
- Assists leadership in the administrative business of the System Physician Executive Leadership Team. Includes document presentation and assures recommendations that require Bylaws changes are drafted for Committee consideration. Deploys such changes to the regional Hospitals as examples of best practice.
- Provides research and administrative support for initiatives that will have system-wide impact e.g. defining and expanding scope of practice for advanced practice providers.
- Directs system initiatives requiring corporate management and reporting through Visual Cactus e.g. the Influenza and COVID-19 Immunization programs. Includes development of procedures and associated documents, communication to the practitioners and Hospitals, collection and documentation of results.
- Support management in the design and development of system level physician initiatives.
- Monthly email distribution of Provider Communications (collaborating with CMIO).
- Performs related accountabilities/responsibilities as required or directed.
Bachelor's Degree or 5 years of related experience. Master's Degree preferred.Experience:
At least 5-7 years' experience in Medical Staff operations with working knowledge of JC and NCQA standards, medico-legal issues and laws. Strong interpersonal and management skills.