Remote Medical Staff Services Health Care Specialist - Medical Staff Services Delegation /Enrollment- Full-Time Days - Mount Sinai Health System : Job Details

Job DescriptionThe Medical Staff Services Health Care Specialist is responsible for coordinating the Mount Sinai School of Medicine Faculty Practice Associates credentialing, re-credentialing and enrollment process in accordance with the Health Care Plans Delegated Credentialing Agreements and the FPA policies & procedures, industry best-practices, and regulatory requirements.Responsibilities1. Coordinates and administers all aspects of the health care plan enrollment process for the Faculty Practice Associates, including: a. FPA- Faculty Practice Associates-Ongoing Auditing & Monitoring of Credentials files; Ensures compliance with the accrediting agencies (i.e., NCQA, JCAHO, NYS and Federal); Preparation of Credentials Files & Credentials Committee Minutes on a monthly basis for FPA; Interaction with CEO of the Faculty Practice b. Manages interaction with Managed Care Plans - Enrollment, Data Exchange, and Updates. Monitors timelines of plan's response and works with Senior Management if performance goals not met. c. Manages Delegated Agreements; Reviews and Audits by plan; Submission of Rosters; Reconciliation of provider enrollment status in plans d. FPA Policy and Procedures review and updates with relation to NCQA, NYS and Federal Standards. e. Provides oversight of the Sub-Delegation Credentialing process for Initial and re-credentialing files. Accountability for accuracy and integrity of the credentialing database-Visual CACTUS f. Collection of data from departmental Faculty Practice Associate physicians; g. Gathering and reviewing enrollment requests, applications and contracts for completeness and accuracy h. Interaction with Health Plan representatives regarding audits; problem and claim resolution; identify fee schedule issues; and addressing potential corrective action plans and monitoring for a successful resolution i. Creating systems records and inputting key data elements to facilitate downstream processing j. Performing independent verifications as required, including; education, training, experience, certifications and boards k. Organizing and presenting documentation for committee review and approval l. Assist Manager in setting up audits and preparation of monthly reports m. Manages others, i.e., Credentials Coordinators on a day-to-day basis n. Ensure that all FPA members are properly and accurately enrolled in Health Care Plans o. Track all appointments, reappointments, change-in-status, demographic updates, and terminations from plans. p. Recording and maintaining key data elements in electronic and hard-copy file systems.2. Prepares status reports of work performed and next steps.3. Facilitates communication between department personnel and Health Care Plans, andMSS Operations.4. Participates in team-based problem solving activities and process improvements.5. Participates in probationary and annual performance evaluations6. Performs other related duties as assigned.QualificationsBachelor's degree or equivalent experience1. Minimum of five (5) years related progressively responsible experience in health care administration with general knowledge of Medical Staff Office functions.2. Preferred experience in Health Care Plan Credentialing/Provider Relations and/or auditing setting, or Hospital Health Care EnrollmentAbout UsStrength through Unity and InclusionThe Mount Sinai Health System is committed to fostering an environment where everyone can contribute to excellence. We share a common dedication to delivering outstanding patient care. When you join us, you become part of Mount Sinai's unparalleled legacy of achievement, education, and innovation as we work together to transform healthcare. We encourage all team members to actively participate in creating a culture that ensures fair access to opportunities, promotes inclusive practices, and supports the success of every individual.At Mount Sinai, our leaders are committed to fostering a workplace where all employees feel valued, respected, and empowered to grow. We strive to create an environment where collaboration, fairness, and continuous learning drive positive change, improving the well-being of our staff, patients, and organization. Our leaders are expected to challenge outdated practices, promote a culture of respect, and work toward meaningful improvements that enhance patient care and workplace experiences. We are dedicated to building a supportive and welcoming environment where everyone has the opportunity to thrive and advance professionally. Explore this opportunity and be part of the next chapter in our history.About the Mount Sinai Health System:Mount Sinai Health System is one of the largest academic medical systems in the New York metro area, with more than 48,000 employees working across eight hospitals, more than 400 outpatient practices, more than 300 labs, a school of nursing, and a leading school of medicine and graduate education. Mount Sinai advances health for all people, everywhere, by taking on the most complex health care challenges of our time - discovering and applying new scientific learning and knowledge; developing safer, more effective treatments; educating the next generation of medical leaders and innovators; and supporting local communities by delivering high-quality care to all who need it. Through the integration of its hospitals, labs, and schools, Mount Sinai offers comprehensive health care solutions from birth through geriatrics, leveraging innovative approaches such as artificial intelligence and informatics while keeping patients' medical and emotional needs at the center of all treatment. The Health System includes more than 9,000 primary and specialty care physicians; 13 joint-venture outpatient surgery centers throughout the five boroughs of New York City, Westchester, Long Island, and Florida; and more than 30 affiliated community health centers. We are consistently ranked by U.S. News & World Report's Best Hospitals, receiving high Honor Roll status, and are highly ranked: No. 1 in Geriatrics, top 5 in Cardiology/Heart Surgery, and top 20 in Diabetes/Endocrinology, Gastroenterology/GI Surgery, Neurology/Neurosurgery, Orthopedics, Pulmonology/Lung Surgery, Rehabilitation, and Urology. New York Eye and Ear Infirmary of Mount Sinai is ranked No. 12 in Ophthalmology. U.S. News & World Report's Best Children's Hospitals ranks Mount Sinai Kravis Children's Hospital among the country's best in several pediatric specialties. The Icahn School of Medicine at Mount Sinai is ranked No. 11 nationwide in National Institutes of Health funding and in the 99th percentile in research dollars per investigator according to the Association of American Medical Colleges. Newsweek's The World's Best Smart Hospitals ranks The Mount Sinai Hospital as No. 1 in New York and in the top five globally, and Mount Sinai Morningside in the top 20 globally.Equal Opportunity EmployerThe Mount Sinai Health System is an equal opportunity employer, complying with all applicable federal civil rights laws. We do not discriminate, exclude, or treat individuals differently based on race, color, national origin, age, religion, disability, sex, sexual orientation, gender, veteran status, or any other characteristic protected by law. We are deeply committed to fostering an environment where all faculty, staff, students, trainees, patients, visitors, and the communities we serve feel respected and supported. Our goal is to create a healthcare and learning institution that actively works to remove barriers, address challenges, and promote fairness in all aspects of our organization.