Medical Manager
Resume:
**** *. *’Connor Rd.,
Cell: 214-***-****
Email: **********@*****.***
Janet Fain, CPCS, CPMSM
Seasoned Medical Staff Services professional with 25 years’ experience in a variety of healthcare settings in positions ranging from Credentialing Specialist to Director. Strengths include the ability to handle multiple responsibilities while maintaining high standards of excellence both professionally and administratively. Experience includes: Strategic planning, Bylaws revision with concomitant policy development and implementation, including Medical Staff Services software data management and process improvement including FPPE/OPPE. Strengths: Increase Department productivity, staff recruitment, retention and training, maintaining staff motivation during culture change, excellent problem solving, interpersonal, and communication skills.
Experience
06/Engagement 11 to Present Accomplishments: Independent Contractor, Consultant/Interim Staff
• Managed a team of permanent credentialing specialist with interim staffers
• Developed Credentials Committee minutes to meet NCQA and audit standards
• Oversight during completion of data entry to current software positioning facility to consider other alternatives with minimal downtime for data entry to any new software if decision is made. Business and processes are documented and logically stored in shared electronic files for legacy.
• Documented department function to include all business lines, job task assignment, and health plans necessary for enrollment and reimbursement
• Collaborated with Legal for the development of policies and procedures to include fair hearing and appeals process
• Transitioned from paper application to CAQH ProView application condensing time between provider approval and health plan enrollment
• Provided interim staffing during staff recruitment including hands- on education and training of Manager, Medical Staff Services and Medical Staff Coordinator
• Provided support and guidance for the day- to- day operations of the Medical Staff Services Department including meeting management, credentialing and privileging processes, auditing and reporting, in both hospital and CVO setting
• Support of the medical staff leadership, administration regarding compliance with internal and external requirements and support of the FPPE and OPPE processes
• Primary source verification and analysis of initial appointments with clinical privileges requests as well as reappointments with renewal of clinical privileges in accordance with CMS, The Joint Commission standards and hospital policy at multiple sites
• Participate in team projects to reorganize the Medical Staff Services
• Create and/or revise privilege forms including data entry to the credentialing software
• Assist with The Joint Commission (TJC) and other regulatory survey preparation
• Review and update medical staff bylaws and department policies & procedures
• Create FPPE/OPPE forms and data collection tools 10/10 – 5/11 Vistar Technologies, Provider Data Management Software Consultant/Subject Matter Expert
• Developed working relationships with project managers, and end users; tested data for conversion, created desktop and workflow procedures; and attended virtual meetings for the purpose of applying expertise within the scope of medical staff services management
• Assisted in streamlining provider enrollment process 4503 N. O’Connor Rd.,
#1114 Irving, TX 75062
Cell: 214-***-****
Email: **********@*****.***
Janet Fain, CPCS, CPMSM
3/06 – 10/10 North Hills Hospital, an Affiliate of HCA, NRH, TX Director, Medical Staff Services – Accomplishments include:
• As working Director of Medical Staff Services I accepted responsibility for credentialing and privilege maintenance of approximately 500 practitioners
• Improved workflow by the re- organization and training of a team of two Coordinators. The improved workflow was accomplished by division of work load into clinical departments assigning specific responsibility to each Coordinator for end to end processing of practitioner privileges. This facilitated cross training for the purpose of avoiding delay in practitioner availability for patient treatment, as well as increased job satisfaction
• We brought current the credentials of approximately 300 out- of- compliance providers' credentials during the first year
• Review and update of medical staff bylaws
• Developed Physician Orientation program
• Maintained compliance with all Joint Commission and CMS Standards, State statutes, and corporate compliance standards and assisted with Developed policy/procedures (training materials) in compliance with Joint Commission and CMS standards and assisted with The Joint Commission (TJC) preparation activities
• Directed data conversion of credentialing software & implementation of standardized credentialing initiative; Created privilege forms and entered those forms into the credentialing software
• Left management level successor
12/04–2/06 UT Southwestern University Hospitals DFW, TX Manager, Medical Staff Services– Accomplishments include:
§ As working Manager of Medical Staff Services for Zale Lipshy & St. Paul University Hospitals we brought approximately 1400 practitioners compliant with Joint Commission and CMS standards
§ Developed team of five professional Medical Staff Coordinators, during merge of two hospitals with different cultures, mission and values
§ Developed orientation for clinical Department Chairman around hospital- based medical staff leadership responsibilities
§ Directed conversion of credentialing software & implementation of standardized credentialing initiative; Created privilege forms and entered those forms into the credentialing software
§ Developed policy/procedures (training materials) in compliance with Joint Commission and CMS standards and assisted with The Joint Commission (TJC) preparation activities
2/00–12/04 Baylor Health Care System DFW, TX
Manager, Medical Staff Services– Accomplishments include:
• As working Manager of Medical Staff Services for Baylor Regional Medical Center at Grapevine, we maintained credentialing/recredentialing production of approximately 600 practitioners
• Developed three member professional Coordinator team divided by clinical department
• Developed policy/procedures (training materials) in compliance with Joint Commission and CMS standards and assisted with The Joint Commission (TJC) preparation activities
• Developed Physician Orientation for Department Chairmen
• Maintained Continuing Medical Education program
• At Baylor Medical Center at Waxahachie, I organized and brought current Medical Staff Services after personnel abandonment 4503 N. O’Connor Rd.,
#1114 Irving, TX 75062
Cell: 214-***-****
Email: **********@*****.***
Janet Fain, CPCS, CPMSM
• Review and update of medical staff bylaws at both facilities
• Implemented automated credentialing & privileging software at both facilities Education Business Administration LeTourneau University (60 credit hours) National Association of Medical Staff Services Certification #20857 CPCS maintained since- September 1996
CPMSM maintained since November 2002
Memberships
& Affiliations
National Association Medical Staff Services Texas Society of Medical Services Specialists 2009 Board Member at Large Local Chapter FWD- MSP Chapter 2009 Bylaws Committee Chairman
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