Job Specifications
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Description
This position works with the SlU HealthCare medical staff to gather information required for credentialing and also provides assistance and support to the Senior Director of Patient Business Services by performing specialized office support duties. The Medical Staff Office is responsible for the contracting, credentialing, and re-credentialing of SIU HealthCare with managed care health plans and hospitals. Responsibilities also include e maintaining the physician database, serving as a resource to physicians, clinic staff, and patients concerning physician health plan participation, and coordinating other aspects of plan participation, including arranging for and coordinating staff training and site visits, distributing provider manuals and updates, and reviewing provider directories. This position works directly with the providers and managed care plans to prov ide information and solve problems that may occur during the credentialing and re-credentialing processes.
Examples of Duties
Medical Staff Duties 75%
Manages deadlines and priorities in gathering information and completing managed care plan applications.
Works with online systems for Medicare and Medicaid to credential and recredential providers.
Keeps all Medical Staff department informed as to progress of information gathering. Works with providers to resolve deficiencies.
Resolves problems related to credentialing and re-credentialing for the managed care plans. Works with provider representatives directly in regard to additional information that may be needed to complete credentialing.
Compiles and maintains updated provider information and initiates calls to the various Departments and physicians to obtain specific current information, such as updated physician licenses, board certifications, narcotic licenses, physician health care plan applications, and C.V.' s.
Responsible for initiating and maintaining a current file for each employed member of SIU Physicians & Surgeons Inc. which includes all NCQA required documentation for credentialing. Much of the information is found utilizing internet search engines.
Maintains credentialing database, including uploading documents preparing applications and reports, and assisting department users.
Responsible for managing their own alpha split of providers.
Clerical Duties 25%
Composes letters and memoranda containing confidential or sensitive information as requested, which very often require in depth knowledge of managed care procedures.
Types from drafts, documents such as procedures policies, memoranda, managed health care provider credentialing applications, informational notices to managed health care plans, and special project reports. Corrects typographical, spelling, punctuation, and grammatical errors.
Coordinates arrangements for meetings and training sessions by notifying participants, acquiring conference rooms, and arranging any catering of food. Responsible for apprising the Director of Managed Care of all meetings. Obtains materials needed to assure a productive outcome.
Greets physicians and other visitors, answers telephones, screens calls, and handles as many calls as possible and takes accurate telephone messages for the staff in the Medical Staff Office. Projects a professional, efficient image and maintains a courteous and friendly attitude.
Responsible for maintaining, preparing and distributing quarterly agendas of the Managed Care Networking Group (MCNG).
Responsible for insuring meeting room has the equipment necessary for any presentations made to the group, including telephone
conferencing and webinars. Accompanies the Medical Staff Specialist II to all MCNG meetings and other meetings as requested.
Independently prepares spreadsheets and inputs data into various spreadsheets utilizing the Excel and Microsoft Word programs on the computer. Prepares reports from those databases including New Provider Credentialing Status report, for distribution to department management.
Supervises the maintenance of comprehensive files and records system for a large area, which includes confidential information and maintains a current listing of all files utilized by the Medical Staff Office.
Responsible for requesting health care plan specific Certificates of Insurance for Professional Liability Insurance for members of SIU Physicians & Surgeons, Inc.
Sensitive to the needs of underrepresented minority populations
Qualifications
Credentials to be Verified by Placement Officer
High school diploma or equivalent.
Any one or combination totaling two (2) years (24 months) from the categories below:
College coursework in health care administration, health information technology, health sciences, public health, social sciences, business administration, or a closely related field, as measured by the following conversion table or
About the Company
SIU Medicine is a growing medical school and clinical provider nationally recognized for its innovative medical education, cutting-edge research and quality health care. The diversity of work environments available at the school provides employees with the opportunity to contribute to a wide variety of areas including academic, health care, research, administrative and service/maintenance.
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