Under the direction of the Sr. Director of Physician Operations, the Faculty Affairs and Credentialing Specialist is responsible for performing and documenting all the administrative tasks and details of the professional staff in compliance with the Departments Faculty Affairs processes (described below). The position works closely with the office of the Chair of Radiology and acts as liaison between all professional staff members and the Department Chair. The position liaises with Human Resources to on-board clinical and research faculty, trainees and students, initiates new hire process, works with the recruit to complete employment required forms, submits payroll and the like. The position serves as the liaison to Harvard Medical School for Department faculty, and interfaces with PHS International Office for visa related issues for Department faculty, trainees and staff. Working with the Department Chair, the Specialist initiates processes for HMS Appointments, re-appointments and reviews for promotion, and coordinates interactions with the Promotions Committee. The position is also responsible for leading, coordinating, monitoring, and maintaining the credentialing and re-credentialing of practitioners with all relevant hospitals, patient care facilities and provider entities, as well as ensuring initial and continuing provider enrollment with relevant client health plans, payers and other entities. Credentialing functions include, but are not limited to, processing credentialing applications, including initial appointment, reappointment, expirables process, as well as clinical privileging for Medical Staff, Allied Health Professionals, and all other providers outlined in the BWHC/BWPO Medical Staff Bylaws, performing primary source verifications and updating and maintaining credentialing database in accordance with internal policies, procedures, client health plan contracts, NCQA guidelines as well as applicable state and federal requirements. The Specialist maintains up-to-date data for each provider in Faculty Affairs databases and online systems; ensure timely renewal of licenses and certifications.
PRINCIPAL DUTIES AND RESPONSIBILITIES:
- Responsible for performing and/or managing the tasks related to all Faculty Affairs processes. Disseminates work to others as required. Faculty Affairs processes include processes related to (i) offers, employment agreements, on-boarding, hiring, firing, payroll, training, and supervision of clinical and research faculty, trainees and students, as well as processes related to appointments, promotions, re-appointments, credentialing and privileging at Harvard Medical School, BWH, Dana Farber Cancer Institute and other institutions or Department clients that may have agreements with the Department for professional services, (ii) the enrollment, renewal, credentialing and re-credentialing of physicians and other providers with client health plans, payers and other entities requiring enrollment or similar processes, and (iii) documenting compliance by faculty with Department, BWPO, BWH, PHS, HMS or other applicable policies (e.g., malpractice insurance, DEA and similar licenses or certifications, professional society requirements, skills maintenance, immunizations, conflicts of interest disclosure, and the like).
- Functions as Department of Radiology resource on Harvard Medical School promotions, appointments and reappointments at the Brigham and Womens Hospital, Dana Farber Cancer Institute, West Roxbury/Brockton Veterans Administration Hospitals and any other institutions or organizations that may now or in the future have agreements for professional services with the Department. Suggests appropriate appointment levels for new appointees. Prepares all appointments, promotions and reappointments for above-mentioned hospitals including drafting letters, reviewing and correcting applications and curriculum vitae into acceptable HMS format. Manages and attends promotion committee meetings and take minutes.
- Initiates various paperwork for all professional appointments, promotions, salaries and visas.
- Monitors monthly payroll, tracing source and amounts of all professional staff salary.
- Responsible to supply Educational Commission for Foreign Medical Graduate and Visa information and regular hours to staff applicants and current staff members. Serves as a resource for visa related issues, recommends Visa types and aides with obtaining proper Visas and permanent residency. Must remain current regarding Immigration and Naturalization rules and regulations and other changes in immigration laws. Must be current on licensing laws pertaining to foreign medical graduates.
- Prepares and submits ads to advertise jobs available for professional staff and fellowships. Maintains Affirmative Action Records on applicants and staff members hired. Drafts Affirmative Action reports on new staff members and submits reports to Harvard Medical School.
- Performs the initial credentialing and re-credentialing functions with all relevant institutions for employed and contracted practitioners, which may include collaborating physicians.
- Reviews provider applications for completion and accuracy and ensures appropriate follow-up; monitors and reports on the credentialing progress of each provider.
- Performs timely and accurate data entry and regularly revises provider and Faculty data as needed to maintain a comprehensive database that records data on all Faculty Affairs processes. Generates reports from such database including routine reports requested by Department leadership and ad hoc reports requested by Department leadership and appropriate BWPO or BWH leaders regarding Faculty Affairs processes or information. Maintains paper copies of information as necessary or appropriate.
- Ensures timely and accurate enrollment, renewals, credentialing and re-credentialing application submissions for each provider as it relates to each client health plan; monitors and reports progress of each provider and follows-up as needed.
- Ensures all providers who require collaboration agreements are appropriately assigned to a collaborating physician and the agreement is executed by both parties; monitors and reports progress of each provider.
- Maintains copies of current state licenses, DEA certificates, malpractice coverage and any other required credentialing documents for all providers. Tracks license and certification expirations for all providers to ensure timely renewals. Ensures practice addresses are current with health plans, agencies and other entities.
- Ensures employed providers are enrolled under the professional liability insurance plan; monitors and reports progress on each provider.
- Responds to all provider, client health plan and internal inquiries in a timely manner within one (1) business day.
- Monitors expiring licensure, board and professional certifications and other expirable documents with providers within the prescribed timeframes as outlined in the policies and procedures, assisting providers with timely renewal as appropriate and escalating to manager and field management as appropriate.
- Conducts sanctions and compliance monitoring and alerts the Director of any undisclosed negative findings immediately.
- Assists traveling providers [e.g. teleradiology] with obtaining new state licenses in areas identified by the clinical management team; monitors and reports progress of each provider.
- Adheres to policies and procedures including timely delivery of completed work and use of resources.
- Identifies, analyzes and resolves extraordinary information, discrepancies, time gaps and other idiosyncrasies that could adversely impact ability to credential and enroll practitioners and ultimately bill and obtain reimbursement for services rendered; discovers and conveys problems to the Director so that the optimal course of action is taken by making sound decisions in accordance with department and corporate guidelines.
- Utilizes extensive internet and telephone communication to obtain critical pertinent information.
- Maintains corporate provider contract files.
- Keeps the Director informed of potential credentialing or enrollment issues.
- Performs miscellaneous job-related duties as assigned.
- Minimum of a Bachelor s Degree
- Minimum of 5 years of progressively more responsible experience in a managerial position is required.
- Directly supervise up to 5 full time employees
- NAMSS certification as a Certified Professional Medical Services Manager (CPMSM) or Certified Provider Credentials Specialist (CPCS) or actively seeking certification and ability to become certified is desired.
- High degree of tact and poise is required to represent the Chair and the Department with members of upper level administration and management for the Hospital and Medical School.
- Ability to communicate effectively, both orally and in writing.
- Program planning and implementation skills.
- Knowledge of related accreditation and certification requirements.
- Knowledge of medical credentialing and privileging procedures and standards.
- Ability to analyze, interpret and draw inferences from research findings, and prepares reports.
- Working knowledge of clinical and/or hospital operations and procedures.
- Informational research skills.
- Ability to use independent judgment to manage and impart confidential information.
- Database management skills including querying, reporting, and document generation.
- Ability to make administrative/procedural decisions and judgments.
- Work is normally performed in a typical interior/office work environment.
- Directly supervise up to nine full time employees.
- Responsible for hiring, firing, training, development and performance evaluations.
Brigham and Womens Hospital is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, creed, sex, sexual orientation, gender identity, national origin, ancestry, age, veteran status, disability.
Primary Location: MA-Boston-Boston - BWH Main Campus Work Locations: Boston - BWH Main Campus 75 Francis St Boston 02115 Job: Admin/Clerical/CustService-Management Organization: Brigham & Women s Hospital(BWH) Schedule: Full-time Standard Hours: 40 Shift: Day Job Employee Status: Regular Recruiting Department: Brigham & Women s Hospital Job Posting: Jun 24, 2019