Supervisor of Medical Affairs & Provider Services at Crouse Hospital – Syracuse, New York

The Supervisor of Medical Affairs and Provider Services is responsible for coordinating and managing all aspects of the credentialing, re-credentialing, and enrollment processes for physicians and advanced practice providers. This position ensures compliance with all hospital, state, and federal regulations, as well as payer and organizational standards. Key responsibilities include obtaining and validating provider documentation, maintaining credentialing databases, verifying qualifications, and facilitating timely onboarding and re-credentialing activities.

The supervisor serves as a liaison between providers, billing companies, malpractice carriers, and leadership teams, ensuring accurate communication and efficient processing of applications. They also provide ongoing support to the Medical Staff Coordinators and the Manager of Medical Staff Administration in various operational and administrative capacities, assisting with special projects, data maintenance, report preparation, and day-to-day department functions to promote seamless workflow and compliance within the medical staff office. Additional duties include maintaining professional licenses and registrations, supporting audits and reporting needs, and assisting with credentialing-related projects and committees. Strong attention to detail, confidentiality, and organizational skills are essential for success in this role.

functional job duties and responsibilities:

1. Initiate the enrollment process for all new providers and mid-levels to include malpractice, billing company and hospital applications.
2. Work closely with physicians and mid-levels to obtain proper documentation for enrollment and onboarding.
3. Conduct source verification and validate documents to ensure accuracy of all credentialing standards, assess completeness of information and qualifications relative to credentialing standards.
4. Identify and analyze highly confidential information and resolve any discrepancies, time gaps and other issue that could adversely impact the ability to credential and enroll providers. Convey to Manager any problems that could delay or adversely impact enrollment process
5. Conduct follow-up with individual providers on a timely basis for onboarding.
6. Prepares, issues and electronically track for follows-up on individual applications to providers (example: MLMIC, PRL, CROUSE HEALTH, HEALTH ALLIANCE PHYSICIAN ORGANIZATION, etc).
7. Maintain data from provider applications into credentialing database.
8. Maintain timeline on enrollment schedules and communicate with leadership team, malpractice insurance company, billing company.
9. Meet with provider one-on-one for any ACO, CMS and NYS guideline requirements.
10. Efficiently perform all aspects of re-credentialing applications to ensure current credential standards are met.
11. Maintain and renew all NYS medical registration certificates, DEA licensing and any other licensing requirements to meet the current standards and guidelines of the provider.
12. Assist billing company for CAQH practitioner data requirements and assist with other requirements for re-credentialing, re-certification and renewal for insurance companies.
13. Notify malpractice insurance company of any terminations or changes to policy coverage for providers.
14. Assist and communicate with all providers and office staff on a day-to-day request for inquiries for malpractice, credentialing and/or any privileging issues that may arise.
15. Prepares reports for various projects within the Crouse Medical Practice.
16. Collaborates with participating clients (Caravan ACO) for providers associated to Crouse Medical Practice and any related issues.
17. Participates in the development and implementation of the credentialing process and onboarding.
18. Actively participate in leadership meetings.
19. Perform other related duties, which may be inclusive, but not listed in the job description.
20. Works closely with Crouse Health Medical Staff and Health Alliance Physician Organization staff.
21. Initiate the enrollment process for all new providers and mid-levels to include Crouse Health hospital and Health Alliance Physician Organization applications.
22. Efficiently perform all aspects of re-credentialing applications to ensure current credential standards are meet for the Crouse Health Network and Health Alliance Physicians Organization.
23. Perform quarterly insurance audits to ensure completeness, accuracy and source verification for provider enrollment with the Health Alliance Physician Organization.
24. Prepares reports for various projects for Crouse Health Network, Crouse Medical Staff and Health Alliance Physician Organization.
25. Assist Crouse Health Risk Management Department with various malpractice issues.
26. Assist Crouse Health Network with any related issued in regards to the ACO.
27. Assist in United HealthCare Medicare Advantage Performance.
28. Ability to assist with Human Resources onboarding requirements.
29. Assess tools available to help with employee benefits.
30. Attends and actively participates in hospital or medical performance improvement councils and committees as requested.
31. Proactively communicates with staff and keeps them informed on a regular basis or as needed; updates staff regarding policy changes in specialized areas.
32. Develops and utilizes department policy statements, scope of service, quality indicators and updates; revises as necessary.
33. Performs staff management functions related to employee selection, on-boarding/orientation, coaching/development, staffing, work assignments, performance management and goal alignment as guided by hospital policy and procedures and collective bargaining unit agreement (when applicable).
34. Participates, collaborates and actively engages in meetings to achieve goals and mutually beneficial outcomes.
35. Conducts regular staff meetings to disseminate hospital and/or department/division information and allows for discussion of staff concerns needing clarification or resolution.
36. Assumes other duties as assigned by department leadership.

minimum education/certification/licensure:

1. Associates Degree in Healthcare Administration, Business, or a related field required; Bachelor’s Degree Preferred