Medical Staff Services Specialist Series

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Employees in this series serve as support and resource personnel for centralized medical staff services in a health care facility. They typically are engaged in such services as implementing procedures involved in the granting of privileges to practice in the facility to prospective professional medical staff members (physicians, dentists, optometrists) in accordance with institutional policies, including such activities as verifying applicants' credentials and the completeness of applications, presenting completed applications to review committees, and communicating status of applications to clinical services and departments; maintaining rosters of medical staff; maintaining documentation of staff credentialing processes for accreditation review by professional groups; advising departments on policies, procedures, and standards; providing staff support to review committees (such as preparing agendas and related materials, keeping minutes); implementing measures to promote staff communications (newsletter, meetings); overseeing or supervising clerical support operations; and maintaining or managing related information systems.

Employees at the upper level are responsible for coordinating the activities of the medical staff services unit and providing staff assistance to officers of the committees or facility administrators (such as when reviewing policies, procedures, guidelines, or goals or during accreditation reviews).

DESCRIPTIONS OF LEVELS OF WORK

Employees at this level provide specialized support and assistance in implementing centralized Medical Staff Services. They work under direct supervision from higher-level staff for a duration of 6 months.

A(n) Medical Staff Services Specialist I typically -

1. uniformly apply clearly defined credentialing or privileging processes to all practitioners/providers;
2. perform a detailed and thorough evaluation of applications, primary source verifications, and sources provided to determine the applicant’s initial eligibility for membership/plan participation. Review application and supporting documents for completeness;
3. process and evaluate privileging requests and evidence of education, training, experience, and competency to determine eligibility for requested privileges;
4. recognize, investigate, and validate discrepancies and adverse information obtained;
5. compile, evaluate, and present the practitioner-specific data collected for review by one or more decision-making bodies;
6. demonstrate an understanding of state and regulatory standards;
7. monitor and/or report sanctions and complaints about all practitioners/providers to the supervisor;
8. securely manage credentialing software as the single source of truth by effectively navigating the software and maintaining data integrity;
9. keeps Medical Staff coordinator informed with regard to work progress; negotiates deadlines and priorities;
10. communicates with staff regarding the flow of information necessary to maintain daily activities within the department as well as other departments (such as the clinical departments);
11. serves as a resource person on medical staff issues, including credentialing processes, by-laws, and committees;
12. performs related duties as assigned.

Employees at this level are experienced Specialists who perform job duties with demonstrated skill and independently execute defined operations and procedures of Medical Staff Services. They work under the direction from higher-level staff.

A(n) Medical Staff Services Specialist II typically -

1. uniformly apply defined credentialing or privileging processes to all practitioners/providers;
2. serve as the main point of contact for practitioners during the application process, providing timely updates and additional information as requested;
3. perform a detailed and thorough evaluation of applications, primary source verifications, and sources provided to determine the applicant’s initial eligibility for membership/plan participation: review application and supporting documents for completeness;
4. process and evaluate privileging requests and evidence of education, training, experience, and competency to determine eligibility for requested privileges;
5. recognize potential discrepancies and adverse information and independently investigate and validate information, applications, primary source verifications, or other sources;
6. compile, evaluate, and present the practitioner-specific data collected for review by one or more decision-making bodies;
7. demonstrate an understanding of state and regulatory standards;
8. monitor and/or report sanctions and complaints for all practitioners/providers to the supervisor;
9. securely manage credentialing software as the single source of truth by effectively navigating the software and maintaining data integrity;
10. comply with internal and external requirements related to verifying the status of all practitioner/provider expirables (e.g., licenses, certifications) by querying approved sources and recommending action(s) to ensure compliance;
11. keeps Medical Staff coordinator informed with regard to work progress; negotiates deadlines and priorities;
12. communicate with staff regarding the flow of information necessary to maintain daily activities within the department and as other departments (such as the clinical departments);
13. serves as a resource person on medical staff issues, including credentialing processes, by-laws, and committees;
14. participates in and contributes to analyzing, designing, and implementing credentialing/privileging processes and operations;
15. participate in surveys and audits of regulatory and accreditation agencies, organizations, or delegated credentialing entities;
16. participate in onboarding and network representative meetings. Establish close working relationships with providers, office managers, professional billing, and payer contacts;
17. performs related duties as assigned.

Employees at this level coordinate and manage the central Medical Staff Services of a health care facility in accordance with the program's goals and objectives. They work under administrative direction from higher-level administration.

A(n) Medical Staff Services Coordinator typically -

1. manage the application of clearly defined credentialing or privileging processes for all practitioners/providers as it applies to eligibility for membership/plan participation, primary source verification and education, training, and competency evaluation;
2. recognize potential discrepancies and adverse information, and independently investigate and validate information, applications, primary source verifications, or other sources;
3. coordinates the presentation of practitioner-specific data, findings, and actions for review by one or more decision-making bodies, key stakeholders, and/or the practitioner as appropriate;
4. demonstrate an advanced understanding of state and regulatory standards;
5. securely manage credentialing software as the single source of truth by effectively navigating the software and maintaining data integrity;
6. comply with internal and external requirements related to verifying the status of all practitioner/provider expirables (e.g., licenses, certifications) by querying approved sources and recommending action(s) to ensure compliance;
7. communicate with staff regarding the flow of information necessary to maintain daily activities within the department and in other departments (such as the clinical departments);
8. serves as a resource person on medical staff issues, including credentialing processes, by-laws, and committees;
9. manage the verification and documentation of expirable using acceptable verification sources to ensure compliance with accreditation and regulatory standards;
10. serve as an escalation point for external queries regarding practitioners’ status, ensuring responses occur in a timely matter;
11. coordinates response for department's participation in surveys and audits of regulatory and accreditation agencies or organizations and delegated entities;
12. advanced understanding of state and regulatory standards;
13. coordinate the monitoring and reporting of sanctions, complaints, and adverse actions for all practitioners/providers to ensure compliance;
14. manage qualified staff to accomplish departmental operations and functions;
15. coordinates and escalate external queries regarding practitioners’ status, responding to a timely matter;
16. performs related duties and executes projects as assigned.

MINIMUM ACCEPTABLE QUALIFICATIONS

CREDENTIALS TO BE VERIFIED BY PLACEMENT OFFICER

1. High school diploma or equivalent.
2. Any one or combination totaling two (2) years (24 months) from the categories below:
   1. College coursework in health care administration, health information technology, health sciences, public health, social sciences, business administration, or a closely related field, as measured by the following conversion table or its proportional equivalent:
      • 30 semester hours equals one (1) year (12 months)
      • Associate’s Degree (60 semester hours) equals eighteen months (18 months)
      • 90 semester hours equals two (2) years (24 months)
      • Bachelor’s Degree (120 semester hours) equals three (3) years (36 months)
   2. Work experience in a medical setting which could include business administration (office administration, billing, collections), customer service, health information technology, medical insurance, patient admission/registration, patient services, or closely related experience.

KNOWLEDGE, SKILLS AND ABILITIES (KSAs)

1. Ability to communicate properly and effectively in verbal and written form with various levels of Hospital, College, and Medical Staff.
2. Ability to work independently, set work priorities and determine short- or long-term goals, and strategies to achieve them.
3. Ability to learn and utilize Medical Staff credentialing software and other information technology-related work products.
4. Ability to learn and apply the content of Medical Staff Organizational Documents.
5. Ability to learn and apply state and regulatory standards for Medical Staff standards.
6. Maintain confidentiality regarding legal matters, privacy issues, information technology, and data integrity.
7. Understand clinical competence evaluation concepts, key functions, terminology, and work products, including evaluation tools and techniques used.
8. Ability to adapt behavior in response to new information or changing circumstances.
9. Understand managed care concepts, key functions, processes, terminology, and work products.

CREDENTIALS TO BE VERIFIED BY PLACEMENT OFFICER

1. High school diploma or equivalent.
2. Any one or combination totaling two (2) years (24 months) from the categories below:
   1. College course work in health care administration, health information technology, health sciences, public health, social sciences, business administration, or a closely related field, as measured by the following conversion table or its proportional equivalent:
      • 30 semester hours equals one (1) year (12 months)
      • Associate’s Degree (60 semester hours) equals eighteen months (18 months)
      • 90 semester hours equals two (2) years (24 months)
      • Bachelor’s Degree (120 semester hours) equals three (3) years (36 months)
   2. Work experience in a medical setting which could include business administration (office administration, billing, collections), customer service, health information technology, medical insurance, patient admission/registration, patient services, or closely related experience.
3. Six (6) months of work experience comparable to that of the Medical Staff Services Specialist I of the series.

KNOWLEDGE, SKILLS AND ABILITIES (KSAs)

1. Ability to communicate properly and effectively in verbal and written form with various levels of Hospital, College, and Medical Staff.
2. Ability to work independently, set work priorities and determine short- or long-term goals, and strategies to achieve them.
3. Ability to learn and utilize Medical Staff credentialing software and other information technology-related work products.
4. Ability to learn and apply the content of Medical Staff Organizational Documents.
5. Ability to learn and apply state and regulatory standards for Medical Staff.
6. Maintain confidentiality regarding legal matters, privacy issues, information technology, and data integrity.
7. Understand clinical competence evaluation concepts, key functions, terminology, and work products, including evaluation tools and techniques used.
8. Ability to adapt behavior in response to new information or changing circumstances.
9. Understand managed care concepts, key functions, processes, terminology, and work products.

CREDENTIALS TO BE VERIFIED BY PLACEMENT OFFICER

1. High school diploma or equivalent.
2. Any one or combination totaling two (2) years (24 months) from the categories below:
   1. College course work in health care administration, health information technology, health sciences, public health, social sciences, business administration, or a closely related field, as measured by the following conversion table or its proportional equivalent:
      • 30 semester hours equals one (1) year (12 months)
      • Associate’s Degree (60 semester hours) equals eighteen months (18 months)
      • 90 semester hours equals two (2) years (24 months)
      • Bachelor’s Degree (120 semester hours) equals three (3) years (36 months)
   2. Work experience in a medical setting which could include business administration (office administration, billing, collections), customer service, health information technology, medical insurance, patient admission/registration, patient services, or closely related experience.
3. Two years (24 months) months of work experience comparable to that of the Medical Staff Services Specialist II of the series.

KNOWLEDGE, SKILLS AND ABILITIES (KSAs)

1. Ability to communicate properly and effectively in verbal and written form with various levels of Hospital, College, and Medical Staff.
2. Ability to work independently, set work priorities, and determine short- or long-term goals, and strategies to achieve them.
3. Ability to utilize Medical Staff credentialing software and other information technology-related work products.
4. Ability to apply the content of Medical Staff Organizational Documents.
5. Apply knowledge, expertise, sound judgment, and other references and resources as necessary to generate and evaluate solutions and recommendations.
6. Ability to apply state and regulatory standards for Medical Staff.
7. Maintain confidentiality regarding legal matters, privacy issues, information technology, and data integrity.
8. Understand clinical competence evaluation concepts, key functions, terminology, and work products, including evaluation tools and techniques used.
9. Ability to adapt behavior and lead, champion, and help others in response to new information or changing circumstances.
10. Understand and apply performance improvement concepts.
11. Understand budget/finance concepts.
12. Understand managed care concepts, key functions, processes, terminology, and work products.