Medical Staff Services Specialist I (U) (4775)

SIU Medicine; Springfield (IL); On-site; USD 36,000 - 48,000; Full time

Job summary

SIU Medicine seeks a Credentialing Specialist to support the Medical Staff Office in credentialing and re-credentialing the SIU HealthCare providers. You will manage information gathering, maintain provider data, and coordinate staff training and site visits.

The role focuses on gathering required data, contacting departments, and ensuring NCQA documentation is up to date. This is an on-site position based in Springfield, IL.

Qualifications

• High school diploma or equivalent verified by placement officer.
• Two years (24 months) in health care admin or related field or coursework.
• Experience with medical staff credentialing processes preferred.

Responsibilities

• Manage deadlines for credentialing and plan applications.
• Credential and re-credential providers using online systems.
• Maintain provider information and NCQA documentation.
• Prepare and distribute agendas and meetings for MCNG.
• Greet visitors, answer calls, and handle confidential information.

Skills

Communication

Independent work

Attention to detail

Discretion/Confidentiality

Adaptability

Medical terms

Education

High school diploma or equivalent

Two years healthcare coursework/experience

Tools

Medical staff credentialing software

Job description

We recommend using the following browsers to complete the application:

Desktop: Google Chrome, Edge with Chromium; Mobile: Google Chrome, Safari.

Description

This position works with the SIU 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 provide information and solve problems that may occur during the credentialing and re-credentialing processes.

*This position is ON SITE only*

Examples of Duties

75% Medical Staff Duties

• A. Manages deadlines and priorities in gathering information and completing managed care plan applications.
• B. Works with online systems for Medicare and Medicaid to credential and recredential providers.
• C. Keeps all Medical Staff department informed as to progress of information gathering. Works with providers to resolve deficiencies.
• D. 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.
• E. 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.
• F. 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.
• G. Maintains credentialing database, including uploading documents preparing applications and reports, and assisting department users.
• H. Responsible for managing their own alpha split of providers.

25% Clerical Duties

• A. Composes letters and memoranda containing confidential or sensitive information as requested, which very often require in depth knowledge of managed care procedures.
• B. 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.
• C. 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.
• D. 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.
• E. 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.
• F. 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.
• G. 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.
• H. Responsible for requesting health care plan specific Certificates of Insurance for Professional Liability Insurance for members of SIU Physicians & Surgeons, Inc.
• I. Sensitive to the needs of underrepresented minority populations

Qualifications

Credentials to be Verified by Placement Officer

1. High school diploma or equivalent.
2. Any one or combination totaling two (2) years (24 months) from the categories below:
   1. 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 its proportional equivalent:
      • 30 semester hours equals one (1) year (12 months)
      • Associate's Degree (60 semester hours) equals eighteen months (18 months)
      • 90 semester hours equals two (2) years (24 months)
      • Bachelor's Degree (120 semester hours) equals three (3) years (36 months)
   2. Work experience in a medical setting which could include business administration (office administration, billing, collections), customer service, health information technology, medical insurance, patient admission/registration, patient services, or closely related experience.

Knowledge, Skills & Abilities (KSA's)

1. Ability to communicate properly and effectively in verbal and written form with various levels of Hospital, College, and Medical Staff.
2. Ability to work independently, set work priorities and determine short- or long-term goals, and strategies to achieve them.
3. Ability to learn and utilize Medical Staff credentialing software and other information technology-related work products.
4. Ability to learn and apply the content of Medical Staff Organizational Documents.
5. Ability to learn and apply state and regulatory standards for Medical Staff standards.
6. Maintain confidentiality regarding legal matters, privacy issues, information technology, and data integrity.
7. Understand clinical competence evaluation concepts, key functions, terminology, and work products, including evaluation tools and techniques used.
8. Ability to adapt behavior in response to new information or changing circumstances.
9. Understand managed care concepts, key functions, processes, terminology, and work products.

Condition of Employment

Pursuant to the State Universities Civil Service System, an out-of-state resident who is hired into this position must establish Illinois residency within 180 calendar days of their start date.

If you require assistance, please contact the Office of Human Resources at [e-mail] or call 217-545-0223 Monday through Friday, 8:00am-4:30pm.

The mission of Southern Illinois University School of Medicine is to optimize the health of the people of central and southern Illinois through education, patient care, research and service to the community.

The SIU School of Medicine Annual Security Report is available online at https://www.siumed.edu/police-security. This report contains policy statements and crime statistics for Southern Illinois University School of Medicine in Springfield, IL. This report is published in compliance with Federal Law titled the "Jeanne Clery Disclosure of Campus Security Policy and Crime Statistics Act".

Southern Illinois University School of Medicine is an affirmative Action/Equal Opportunity employer who provides equal employment and educational opportunities for all qualified persons without regard to race, color, religion, sex, national origin, age, disability, sexual orientation, protected veteran status or marital status in accordance with local, state and federal law.

Pre-employment background screenings required.