Medical Staff Coordinator - BHS
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Medical Staff Coordinator
Behavioral Health Services
Hourly Range: $24.71 – $35.83
Closing Date: June 6, 2022
Job Summary: Under general direction of the Medical Staff Services Manager/Director (MSSM), the Medical Staff Coordinator (MSC) provides a broad range of medical staff services functions including responsibility for the day-to-day coordination of activities to ensure quality in conducting, maintaining, and communicating physician and advanced practice professional credentialing, privileging and primary source verifications. Serves as a resource to, and collaborates with, others to advance the quality of practitioners and patient safety of the facility and the provider network. Assists with the development, planning and implementation of data management processes according to Medical Staff Bylaws and/or the Provider Network Credentialing Program, which facilitates the flow of information between Medical Staff leadership, Medical Staff Committees and the Board.
- Processes initial and recredentialing applications for membership/participation to the Medical Staff/Provider Network according to regulatory standards and governing documents. Assesses information to establish applicant’s initial eligibility, by conducting thorough background investigation, research, primary source verifications and gap analysis utilizing specialized knowledge. Analyzes recredentialing application and supporting documents for completeness, including the need for any additional information.
- Recognizes issues that require additional investigation, validates discrepancies and ensures appropriate and timely follow-up. Assesses for potentially adverse information or concerns and communicates findings with and/or seeks consultation from the MSSM/Medical Staff Leadership. Ensures quality on the content and completeness of finalized practitioner credentials files that may be presented and reviewed by one or more decision-making bodies. Coordinates timely recredentialing reviews, to ensure all practitioners are evaluated and acted on for reappointment/recredentialing within the required regulatory timeframe.
- Verifies and documents expirables using acceptable verification sources to ensure compliance with appropriate accreditation and regulatory standards. Responds to internal and external inquiries, requests and verifications, often of a sensitive nature.
- Assists in the preparation of practitioner performance improvement and quality/competence data (FPPE/OPPE) in clear, concise, and structured reports. Recognizes and evaluates data for possible patterns or trends that may require further assessment. Coordinates appropriate evaluation by physician leaders of data gathered. Communicates findings and/or resulting actions to key stakeholders and practitioners
- Routinely monitors for and reports on sanctions, licensure actions, grievances and complaints to the Credentialing Committee and/or Medical Staff Leadership. Identifies and reports adverse actions taken against a practitioner in accordance with policy and applicable law. Works with the MSSM to facilitate efficient and cost-effective due process that complies with the Medical Staff/Network fair hearing and/or appeals processes, legal and regulatory requirements.
- Maintains a working knowledge of the Governing Documents and accreditation/regulatory requirements pertaining to medical staff/credentialing functions (TJC, CMS, NCQA, state and federal). Participates in the ongoing assessment of Governing Documents to ensure continuous compliance. Assists and participates in regulatory compliance surveys. Maintains “continuous readiness” of all credentials/privilege files that may be judged for acceptability by state and federal regulatory agencies. Maintains and protects the confidentiality of credentialing and peer review information in accordance with state and federal law.
- Maintains the accuracy and integrity of the credentialing database, files, reports and minutes. Develops and implements forms, tools and policies to support credentials management, record-keeping, and internal and external communications. Coordinates Credentialing Committee meetings, prepares agendas, credentialing files, reports, attends meetings and documents minutes and follow-up activities. Drafts and disseminates approval action notifications to practitioners
- In the absence of the MSSM, acts as a liaison to Medical Staff Leadership, Administration and the Governing Board, which may include preparation and presentation of matters at MEC and Board Meetings. Assists and supports other Medical Staff Committees, as assigned. Serves as a resource to the Medical Staff and the Provider Network regarding credentialing matters, medical staff membership and provider participation. Identifies, routes and escalates matters to leadership, as appropriate.
- Assists with practitioner onboarding/off-boarding, which may include coordinating orientations, trainings, network and EMR access authorization, and communicating adds/drops to stakeholders. Assists with provider enrollment and revalidation, continuing education activity pre-approvals and reimbursement processing. Manages and maintains practitioner continuing medical education records. Responsibly manages receipts and completes timely reconciliation for purchasing card transactions.
- Actively seeks and participates in professional development and networking activities related to medical staff regulations and governance.
- Performs other duties and works on short-term and long-term projects, as assigned.
Minimum Qualifications Required:
- Current resident of the state of Wisconsin
- HS Diploma/GED required; Bachelor’s degree preferred
- Five (5) years of recent experience, within the last eight years, in a hospital, CVO or healthcare organization, with increased responsibility during that period in a medical staff services department role performing physician and advanced practice professional credentialing.
- Current CPCS and/or CPMSM certification preferred.
- Intermediate knowledge of all related computer and software applications, such as word processing and spreadsheets
Skills, Knowledge and Abilities:
- Specialized and current working knowledge, understanding and ability to appropriately apply principles, procedures, requirements, regulations and policies under TJC, CMS and NCQA credentialing standards
- Maintains necessary confidentiality regarding legal matters, privacy issues, information technology and data integrity
- Ability to apply specialized credentialing knowledge, expertise, and sound judgment to generate solutions and recommendations
- Exceptional ability to prioritize, organize, and analyze information
- Ability to communicate effectively, both orally and in writing
- Ability to work effectively with Medical Staff Leadership, Medical Staff, APP Staff and Network Providers
- Ability to work collaboratively and foster a cooperative and productive work environment
- Ability to work independently with minimal supervision to meet deadlines and changing circumstances and demands
- Able to lift/carry up to 15lbs as needed.
NOTE: This ORIGINAL APPLICATION is open to qualified residents of the State of Wisconsin at the time of application. Candidates need to submit a full account of their training and experience (i.e., by submitting an up-to-date resume or by fully completing the application) during the application process and may also be asked to take additional written or performance tests as part of the selection process.
APPLICANTS MUST POSSESS MINIMUM QUALIFICATIONS AT TIME OF FILING APPLICATION
Milwaukee County is committed to fostering an equitable working environment, free from discrimination and harassment, on the basis of any characteristic protected by law. We prohibit any form of discrimination, harassment based on race, color, religion, sex, gender, gender identity or expression, sexual orientation, pregnancy, pregnancy related condition, national origin, age, disability, FMLA status, sexual orientation, military status, marital status, or any other category or status that is now or in the future protected by federal, state, and local law. We maintain a drug-free workplace and perform pre-employment substance abuse testing, background checks and pre-employment physicals subject to job requirements. If special accommodations are needed, please contact 414-278-3936.
Effective October 1, 2021, Milwaukee County will require all employees to have completed COVID-19 vaccinations and provide proof of vaccination or have submitted a completed medical or religious exemption and accommodation request. All persons offered a position will be required to provide proof of completed COVID-19 vaccination at time of hire or have submitted a completed medical or religious exemption and accommodation request and been approved for an accommodation prior to hire.
- Job Family 8 - Health
- Job Function 2 Professionals
- Pay Type Hourly
- Min Hiring Rate $24.71
- Max Hiring Rate $35.83
- Required Education High School
- Milwaukee, WI, USA