Medical Staff Services Specialist I (U) (4775)

This position works with the SllJ 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.

The following information is intended to be representative of the work performed by incumbent in this position and is not all- inclusive. The omission of a specific duty or responsibility will not preclude it from the position if the work is similar, related, or a logical extension of position responsibilities.

Demonstrates, by actions, commitment to the mission and the behavioral standards of SIU School of Medicine. Provides excellent service to both internal and external customers through collaboration and partnership; compassion and respect; integrity and accountability; diversity and inclusion; as well as continuous learning and improvement.

75% Medical Staff Duties

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

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

1. Keeps all Medical Staff department informed as to progress of information gathering. Works with providers to resolve deficiencies.

1. 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.

1. 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.

1. 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.

1. Maintains credentialing database, including uploading documents preparing applications and reports, and assisting department users.

1. 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 care procedures.

1. 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.

1. 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.

1. 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.

1. 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.

1. 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 departmentmanagement.

1. Supervises the maintenance of comprehensive files and records system fora large area, which includes confidential information and maintains a current listing of all files utilized by the Medical Staff Office.

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

1. Sensitive to the needs of underrepresented minority populations

This position requires excellent organizational skills and the ability to coordinate and control a large, complex workload with varying priorities. This position requires knowledge of credentialing and primary source verification. Experience in completing managed care applications and the use of Medicare and Medicaid on line systems is preferred. This position requires excellent computer skills. The individual in this position must be able to work independently and exercise judgment in order to be able to analyze and investigate a variety of questions and/or problems.

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.

If you require assistance, please contact the Office of Human Resources at hrrecruitment@siumed.edu 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.