The Director for Medical Staff Affairs provides leadership, accountability and direction to the Medical Staff Office and Provider Enrollment departments. The director is responsible for departmental strategic planning, business development, software integration and alignment and day to day operations of Medical Staff Services. Functions as the hospital?s expert and stays current in all matters related to credentialing and privileging of providers and their enrollment in insurance plans. Identifies changes to standards and develops innovative approaches to ensure compliance with state, federal, and regulatory standards, regulations and accreditation. Creates a customer service oriented framework and approach to the department?s work. Creates a culture of engaged colleagues through promotion of Lahey guiding principles and the development, mentorship and creation of a positive service oriented work culture.
Essential Duties & Responsibilities including but not limited to: 1. Provides leadership and strategic direction to the Medical Staff Services Department and is responsible for the accurate and timely credentialing, privileging and insurance plan provider enrollment processes.
2. Develops innovative strategies for improvement to ensure optimal functioning of the department and compliance with all state, federal and regulatory requirements, policies and processes.
3. Ensures compliance with Managed Care delegated credentialing contracts, policies and procedures; directs preparation and coordination of credentialing audits and mandated reporting in compliance with the Managed Care Delegated credentialing contracts.
4. Works collaboratively with all Lahey Health System entities for development of provider enrollment system strategies.
5. Ensures that the Medical Staff Bylaws are current with state, federal and regulatory requirements and that all processes of credentialing, privileging and medical staff appointment of physicians and relevant licensed independent practitioners are in compliance with the bylaws.
6. Reviews, interprets and provides considered and timely advice to the senior leadership team regarding regulatory guidelines, including medical staff bylaws, corrective actions and the fair hearing process, rules, regulations and policies.
7. Reviews, oversees and advises medical staff leadership and hospital administration regarding credentialing/privileging of appointments, reappointments, and privilege expansion/reduction requests; assesses whether individuals with clinical privileges provide services within the scope of privileges.
8. Develops and directs systems and processes for professional practice evaluation of new and existing medical staff members.
9. Advises and supports the relevant Medical Staff Committees on matters of medical staff credentialing, professional practice evaluation and review and implementation of practice evaluation and performance improvement plans.
10. Develops, directs and maintains systems for the organization of the Medical Staff governance and committee structure, including committee charter development and maintenance, ensuring committee reporting and information flow through the appropriate reporting lines of the organization.
11. Handles with discretion issues that are significant, complex, multidisciplinary, sensitive, and confidential. As a liaison between the senior leadership and external constituents, exercises best judgment and decision making while providing effective and appropriate leadership to staff.
12. Develops implements and monitors the operating budget for the department. The Director is accountable for all budgetary matters including variances. Frequently assesses the productivity of department and develops business plans to ensure effective business operations.
13. Directs the development, enhancement and maintenance of the credentialing database; assures accuracy of data entry; monitors critical data for analysis and coordinates functional report generation.
14. Creates a culture of excellence and customer service in all processes with all internal and external customers including current and future members of the medical staff and other providers, clinical and administrative leaders and all external representation of Lahey Health.
15. Direct responsibility for hiring, training, mentoring and ongoing professional development of all team members.
Education: Work requires the knowledge of theories, principles, and concepts typically acquired through completion of a graduate degree in business administration or public administration or a closely related field and four to five years of experience in leading a Medical Staff Office or with a combination of education and experience commensurate with a graduate degree as mentioned above.
Licensure, Certification & Registration: Dual certification as Certified Professional in Medical Services Management (CPCSM) and Certified Provider Credentialing Specialist (CPCS) or Certified Professional in Healthcare Quality (CPHQ), or willingness to achieve said certifications within 2 years.
Experience: 3-5 years? experience in Hospital administration at the executive level; 5-7 years directing Medical Staff Services in an academic medical center and/or complex health system.
Skills, Knowledge & Abilities: Work requires the analytical skills necessary to resolve problems requiring a professional level of knowledge in a specific discipline/field and/or improve enhance or upgrade complex clinical, financial, data processing, marketing or human resources systems and programs as well as knowledge of ECHO (Heathline Systems) credentialing software and associated applications, preferred.
Work requires the ability to effectively manage the employees within assigned unit/department and to persuade and negotiate with peer level managers on issues and programs that impact assigned unit/department. Work requires effectively dealing with conflicting views or issues and mediating fair and workable solutions. Shift
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At Lahey Hospital & Medical Center, as one of the world's premier health care organizations, we provide superior health care leading to the best possible outcome for every patient. We exceed our patients' high expectations for service each day. We also help advance medicine through research and the education of tomorrow's health care leaders
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