Medical Staff Services Specialist l (U) 4775

This position reports to the Manager of Provider Credentialing, who reports to the Executive Director - Revenue Cycle who reports to the Associate Provost of Finance and Administration for SIU Medicine, who reports to the Dean/CEO of SIU Medicine.

75% Medical Staff Duties

1. Manages deadlines and priorities in gathering information and completing managed care plan applications.

2. Works with online systems for Medicare and Medicaid to credential and re­ credential providers.

3. Keeps all Medical Staff department informed as to progress of information gathering. Works with providers to resolvedeficiencies.

4. 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.

5. 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.

6. 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 searchengines.

7. Maintains credentialing database, including uploading documents preparing applications and reports, and assisting departmentusers.

8. Responsible for managing their own alpha split of providers.

25% Clerical Duties

1. Composes letters and memoranda containing confidential or sensitive information as requested, which very often require in depth knowledge of managed careprocedures.

2. Types from drafts, documents such as procedurespolicies,memoranda, managed health care provider credentialing applications, informational notices to managed health care plans, and special project reports. Corrects typographical, spelling, punctuation, and grammaticalerrors.

3. Coordinatesarrangementsformeetingsandtrainingsessionsbynotifying 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.

4. 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.

5. 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.

6. 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.

7. 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.

8. Responsible for requesting health care plan specific Certificates of Insurance for Professional Liability Insurance for members of SIU Physicians & Surgeons, Inc.

9. Sensitive to the needs of underrepresented minority populations

1. High school diploma or equivalent.
2. Any one or combination totaling two (2) years (24 months) from the categories below:
3. 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)

1. 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.