Director, Medical Staff Services & CVO- RHN

Job Description Summary

This leadership position is accountable for the management and operations of the Credentialing Verification Office (CVO) and oversight and integration for the medical administrative and medico-legal aspects for the Medical Staff organization as well as the credentialing and enrollment for the MUSC Health delegated carriers utilizing TJC, NCQA, CMS guidelines or other accrediting bodies as required. In consultation with the Market Chief Medical Officers, the Director, Medical Staff Services and CVO is an essential link enhance good communications and a positive working relationship.

Entity

Medical University Hospital Authority (MUHA)

Worker Type

Employee

Worker Sub-Type​

Regular

Cost Center

CC004926 SYS - Credentialing and MSO

Pay Rate Type

Salary

Pay Grade

Health-35

Scheduled Weekly Hours

40

Work Shift

Day (United States of America)

Job Description

High level of interpersonal skills is necessary to handle sensitive and confidential situations. Position requires a high degree of demonstrated poise, tact and diplomacy when interfacing with influential persons within and outside the Hospital. Analytical ability, independent problem solving, and decision skills are required to react quickly and efficiently to various complex administrative and medical staff problems. The ability to adapt to flexible work schedule and frequent interruptions is needed. Possess intelligence and willingness to improve. Role models professional behavior, is self-directed, and demonstrates integrity.
•    Ensure that the organization and staff are in accordance with organizational, client and industry standards and regulations (CMS, NCQA, URAC, etc.)
•    Maintain accuracy of MD Staff
•    Assist/coach/coordinate with Credentialing Manager(s) on a consistent basis, as well as other departments.
•    Provides leadership to establish credentialing best practices and oversee the credentialing process to meet targeted go-live dates for new/existing health plan partners.
•    Develops processes for scaling operations and summarizes the complexity of data and operations into clear explanations.
•    Identifies and implements process efficiencies to ensure a streamlined approach to credentialing.
•    Develops and implements a quality program to ensure accuracy of information and timeliness of submissions.
•    Supports credentialing regulatory activities, including auditing partners and reporting any risks in the network to regulators and leadership.
•    Provides analytical support and leads the process of collecting, analyzing, and reporting credentialing metrics
•    Research government and state requirements for credentialing in new locations and collaborate with other leaders to identify issues and opportunities that lead to achieving department and company goals.
•    Builds relationships with insurance plans and confirms that the credentialing process is current based on insurance requirements.
•    Assists with gathering billing information needed for new contracts.
•    Performs other related duties as assigned or needed for business continuity.

Additional Job Description

Minimum Qualifications:
1. Bachelor’s degree in medical staff services science, business administration, management, or other related field required. May consider 10 years’ experience in a supervisory role overseeing Medical Staff credentialing processes in lieu of degree.
2. Medical Staff Services Certification by NAMSS required. (CPMSM or CPCS)
3. Minimum of five years medical staff experience and supervisory experience required.
4. Comprehensive knowledge of medical staff office functions and responsibilities required.
5. Work requires knowledge of medico-legal issues and awareness of the legal ramifications of hospital documentation and hospital and physician liability.
6. Work requires excellent command of the English language and extensive knowledge of medical terminology and technology.

If you like working with energetic enthusiastic individuals, you will enjoy your career with us!

The Medical University of South Carolina is an Equal Opportunity Employer. MUSC does not discriminate on the basis of race, color, religion or belief, age, sex, national origin, gender identity, sexual orientation, disability, protected veteran status, family or parental status, or any other status protected by state laws and/or federal regulations. All qualified applicants are encouraged to apply and will receive consideration for employment based upon applicable qualifications, merit and business need.

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