Meet Our Compliance Expert: Mark Hirschhorn

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Meet Mark Hirschhorn, the VP of Compliance at andros. Since 2019, Mark has been an integral part of the andros team, working closely with all departments to ensure compliance with the National Committee for Quality Assurance (NCQA) standards and measures. His responsibilities include providing clients with guidance and support in areas such as policy and procedure development, delegated credentialing applications, and delegated provider audits.

Mark’s extensive experience in the healthcare industry and his commitment to compliance standards make him an invaluable member of the andros team. We are grateful for the leadership and expertise he provides in all aspects of our operations. Read on to learn more about Mark’s background, accomplishments and the important role he plays in contributing to the company’s success.

You have more than two decades of experience in the healthcare industry. How have you seen the industry change over the course of your career, and how have those changes affected your work?

The biggest change that I have seen, and still see happening, is the continued move towards automation. When I first started in this field, credentialing was primarily done manually and involved a lot of paperwork to obtain the required primary source verifications. To put it into perspective, the introduction of the fax machine was seen as a big development in speeding up the primary source verification process because you no longer had to physically mail verification requests. While the introduction of automation has certainly helped to streamline the credentialing process, there is still a lot of room for more integration of automation to further streamline the process.

Furthermore, the role of the credentialing professional has also evolved significantly. Now, credentialing professionals are responsible for more than credentialing and need to be versed in provider enrollment, quality control, and managed care just to name a few areas to meet the demands of the job. 

How has your experience working with health plans, provider organizations, and other healthcare entities shaped your approach to compliance and credentialing, and how do you bring those perspectives to your work at andros?

Working with several different types of entities has given me a comprehensive understanding of compliance and credentialing as well as the ability to balance the needs of different stakeholders in the ecosystem. What might be a compliant process for a health plan may not be compliant for a provider organization, as different types of organizations follow different accreditation or certification standards. This makes it so very important to not try and fit a “round peg in a square hole.” You must understand the type of organization you are working with, what their specific organizational needs are, and how their requirements may differ from other organizations.

As the VP of Compliance at andros, you work with various teams to ensure compliance with NCQA standards as well identify and correct compliance gaps. Can you walk us through a recent project you worked on, and how you collaborated with other departments to achieve the desired outcome?

Any form of Compliance is a TEAM effort. Compliance is everyone’s responsibility. As andros continues to prepare for its next NCQA CVO recertification survey, the andros Compliance Department will begin meeting regularly with stakeholders throughout the organization to ensure everyone has a very clear understanding of what they are responsible for as well as a very clear timeline of when their deliverables are due. Having a well defined project plan goes a long way in making sure the lead up to the recertification survey goes as smoothly as possible. 

In addition to managing internal compliance at andros, another key aspect of my role is helping andros’ clients maintain compliance within their own organizations. This requires close collaboration with our clients to provide support for Delegated Credentialing audits as well as assess existing Policies and Procedures to ensure they meet the standards set by the health plan’s decision-making body. For those organizations just getting started with delegated credentialing, we work with them to develop and document compliance policies and procedures to meet all necessary requirements and streamline the review process. Overall, my role focuses on creating, maintaining and advising on compliance policies and procedures, as well as other credentialing related topics.

How has your involvement with NAMSS impacted your career, and what do you hope to achieve in your role as a Director at Large on the NAMSS Board of Directors?

I have to first recognize my almost 10 years as a Board member with NYSAMSS. The knowledge and experience I gained from this role have proven to be invaluable as I have transitioned from a state-level position to a more national-level one.  Being involved with both NYSAMSS and NAMSS has allowed me to meet and form lifelong friendships with so many terrific people. Furthermore, it  has also been a great resource in keeping up with the latest developments in the credentialing and compliance industry, which is invaluable to my role with andros. 

In my current role as Director at Large with NAMSS,  I hope to continue to assist the states I work with to have their state associations and their members function at the highest level possible and continue to have the best experience possible while increasing their credentialing knowledge.

Your experience also includes provider contracting, negotiation, management, and policy and procedure development. How do you utilize that knowledge to be effective in your role at andros?

A big part of my role at andros is to be a resource to others, both internally and externally.  Having strong foundational knowledge allows me to better serve as a resource and help educate others on the upstream and downstream implications of the business problems we tackle daily for our clients.

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