Senior Medical Staff Services Specialist

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Job Description Summary

The Senior Medical Staff Services Specialist is a vital member of the Medical Staff Services team, instrumental in ensuring the efficient and compliant execution of all medical staff credentialing, privileging, and re-credentialing processes within a dynamic academic medical center/health system. This role demands a high degree of independent judgment, advanced problem-solving skills, and a comprehensive understanding of relevant accreditation standards (e.g., The Joint Commission, NCQA), state and federal regulations, and medical staff bylaws. The Senior Specialist works closely with medical staff leadership, department chairs, hospital administration, and other internal and external stakeholders to uphold the highest quality of patient care through robust physician and allied health professional oversight.

CORE JOB FUNCTIONS                                                                                                                                                            

Credentialing & Privileging:

• Performs and monitors the credentialing and re-credentialing process for physicians, advanced practice providers (APPs), and other allied health professionals, ensuring timely and accurate primary source verification.
• Reviews and analyzes complex credentialing files, identifying and resolving discrepancies or potential issues.
• Reviews and analyzes complex credentialing files, identifying and resolving discrepancies or potential issues.
• Prepares comprehensive files for review by department chairs, medical staff committees, and the Board of Directors.

Medical Staff Governance & Bylaws:

• Provides expert guidance on medical staff bylaws, rules and regulations, and organizational policies.
• Assists in the development, revision, and interpretation of medical staff documents.
• Supports medical staff committees (e.g., Medical Executive Committee, Credentialing Committee, Peer Review Committee) by preparing agendas, recording accurate minutes, and ensuring follow-up on action items.
• Maintains official medical staff records and ensures compliance with document retention policies.

Compliance & Accreditation:

• Ensures continuous compliance with The Joint Commission (TJC), National Committee for Quality Assurance (NCQA), CMS, state licensing boards, and other relevant regulatory and accreditation standards.
• Participates in and supports internal and external audits and surveys.
• Stays current with changes in healthcare regulations, accreditation standards, and industry best practices related to medical staff services.

Data Management & Reporting:

• Maintains accurate and up-to-date provider data in credentialing software (e.g., Cactus, MD-Staff) and other relevant databases.
• Generates reports and provides data analysis related to credentialing, privileging, and medical staff activities as requested.

Team Support & Mentorship:

• May provide guidance and support to less experienced team members, sharing expertise on complex cases or processes.
• Supports medical staff committees (e.g., Medical Executive Committee, Credentialing Committee, Peer Review Committee) by preparing agendas, recording accurate minutes, and ensuring follow-up on action items.

Customer Service & Communication:

• Cultivates strong working relationships with medical staff members, department administrators, and other stakeholders.
• Provides excellent customer service and professional communication, both written and verbal.
• Handles sensitive and confidential information with discretion and professionalism.

This list of duties and responsibilities is not intended to be all-inclusive and may be expanded to include other duties or responsibilities as necessary.

CORE QUALIFICATIONS                                                                                                         

Education:

Bachelor’s degree in healthcare administration, business administration, or a related field preferred.

Certification and Licensing:

Certified Professional Medical Staff Management (CPMSM) or Certified Provider Credentialing Specialist (CPCS) highly preferred.

Experience:

• Minimum of 5 years of progressive experience in medical staff services, credentialing, and privileging within a hospital or health system setting.
• Experience in an academic medical center or large, complex health system highly preferred.
• Prior experience with accreditation surveys (TJC, NCQA) is essential.

Knowledge, Skills and Attitudes:

• Comprehensive knowledge of medical staff services operations, including credentialing, privileging, and medical staff governance.
• In-depth understanding of TJC, NCQA, CMS, and state regulatory requirements related to medical staff.
• Proficiency in medical staff credentialing software (e.g., Cactus, MD-Staff).
• Excellent organizational skills, attention to detail, and ability to manage multiple priorities in a fast-paced environment.
• Strong analytical and problem-solving skills.
• Exceptional written and verbal communication skills, with the ability to effectively interact with all levels of staff and leadership.
• Proficiency in Microsoft Office Suite (Word, Excel, PowerPoint, Outlook).
• Ability to work independently with minimal supervision and as part of a team.
• High degree of professionalism, integrity, and confidentiality.

The University of Miami offers competitive salaries and a comprehensive benefits package including medical, dental, tuition remission and more.

UHealth-University of Miami Health System, South Florida's only university-based health system, provides leading-edge patient care powered by the ground breaking research and medical education at the Miller School of Medicine. As an academic medical center, we are proud to serve South Florida, Latin America and the Caribbean. Our physicians represent more than 100 specialties and sub-specialties, and have more than one million patient encounters each year. Our tradition of excellence has earned worldwide recognition for outstanding teaching, research and patient care. We're the challenge you've been looking for.

The University of Miami is an Equal Opportunity Employer - Females/Minorities/Protected Veterans/Individuals with Disabilities are encouraged to apply. Applicants and employees are protected from discrimination based on certain categories protected by Federal law. Click here for additional information.

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