Medical Staff Services Supervisor
- East Wenatchee, WA
- Permanent
- Full-time
OverviewLocated in the heart of Washington, we enjoy open skies, snow-capped mountains, and the lakes and rivers of the high desert. We are the proud home of orchards, farms, and small communities. Confluence Health actively supports the communities we serve and their quality of life through our community support program and through our individual efforts as involved community members.Full Time Employees of Confluence Health receive a wide range of benefits in addition to compensation.
- Medical, Dental & Vision Insurance
- Flexible Spending Accounts & Health Saving Accounts
- CH Wellness Program
- Paid Time Off
- Generous Retirement Plans
- Life Insurance
- Long-Term Disability
- Gym Membership Discount
- Tuition Reimbursement
- Employee Assistance Program
- Adoption Assistance
- Shift Differential
SummarySupervises departmental activities to ensure quality and accuracy in processing, maintaining, and communicating regarding provider and facility credentialing, privileging and enrollment. Maintains knowledge of Medical Staff & Enrollment regulatory requirements. Maintains current standard processing knowledge of team duties and provides daily leadership to all Medical Staff Services team members.Position Reports To: Provider Services Director
Essential Functions
- Maintains knowledge and understanding of all team member guide sheets and processes. Reviews team member guide sheets annually and recommend improvements. Ensures consistency and maintenance of deliverables on all guide sheets.
- Maintains advanced knowledge of the Medical Staff Documents and ability to apply DNV, NCQA, CMS, DOH or other regulatory standards to CH Provider and Facility needs.
- Prepares reports and e-files required for surveyors. Assists enrollment team member with complex health plan inquiries, as needed. Coordinates the annual health plan audit process, including needed policy updates annually.
- Coordinates provider quality reappointment reporting needs. IPPE backup if assigned.
- Coordinates re-credentialing second checks and assists initial team members with second check needs, during peak times.
- Coordinates initial credentialing of select provider types, if assigned.
- Generation of roster needs, and coordination of Health plan inquiries, if assigned.
- Coordinates file review, summary preparation, agenda, invites, minutes and database updates for Credentials Committee meeting monthly.
- Coordinates monitoring logs monthly and reports as received, if assigned.
- Assists with Project Management, if assigned.
- Assists with onboarding and training new internal and provider staff, as directed.
- Completes staff schedules and team oversite, including annual reviews.
- System Administrator for credentialing database.
- Performs other duties as assigned.
QualificationsRequired:
- Experience with DNV, NCQA, URAC, DOH and CMS health plan enrollment, auditing, medical staff services and facility credentialing standards.
- Minimum of 5 years experience in medical staff services or provider enrollment.
- Must have successfully completed an AA or Bachelor's degree (previous work experience considered in lieu of education requirement).
- Medical terminology knowledge.
- Effective team-building skills that show consideration, acceptance and concern for the needs and feelings of others.
- Certified Provider Credentialing Specialist (CPCS), required within 12 months of hire, must maintain 30 CME credits every three years.
- Lean training experience.
- Provider Enrollment Certificate (PSEC).
- Certified Manager Medical Staff Services (CPMSM), must maintain 45 CME credits every three years.
- Walking - O
- Sitting/Standing - C
- Reaching: Shoulder Height - O
- Reaching: Above shoulder height - O
- Reaching: Below shoulder height - O
- Climbing - O
- Pulling/Pushing: 25 pounds or less - O
- Pulling/Pushing: 25 pounds to 50 pounds - O
- Pulling/Pushing: Over 50 pounds - O
- Lifting: 25 pounds or less - O
- Lifting: 25 pounds to 50 pounds - O
- Lifting: Over 50 pounds - O
- Carrying: 25 pounds or less - O
- Carrying: 25 pounds to 50 pounds - O
- Carrying: Over 50 pounds - O
- Crawling/Kneeling - O
- Bending/Stooping/Crouching - O
- Twisting/Turning - C
- Repetitive Movement - C
- General office environment.
- FLSA: Exempt
- Hourly/Salary: Salary
- Unprotected Heights - No
- Heat - No
- Cold - No
- Mechanical Hazards - No
- Hazardous Substances - No
- Blood Borne Pathogens Exposure Potential - No
- Lighting - No
- Lighting - No
- Noise - No
- Ionizing/Non-Ionizing Radiation - No
- Infectious Diseases - No