Medical staff services manager

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Description

Under the direction of the Director, Managed Care & Credentialing, this position is responsible for the management of provider onboarding, licensing, credentialing and enrollment for SIU Healthcare and SIU School of Medicine (FQHCs). The incumbent is responsible for the daily supervision of the staff assigned to the Credentialing Team. The incumbent is responsible for streamlining existing processes, creating efficiencies and maintaining a computerized credentialing system to ensure compliance with federal and state regulations regarding licensure and certification of medical providers to overall ensure timely and accurate credentialing, privileging and health plan enrollments for SIU providers. The incumbent will be responsible for assuring that SIU Medicine credentialing and recredentialing files comply with National Committee for Quality Assurance (NCQA) standards and requirements. The incumbent serves as a liaison between SIU Healthcare and SIU School of Medicine (FQHCs}, providers, individual departments and outside organizations in managing the credentialing, licensing and enrollment for provider privileges in a timely, well-communicated manner that can be easily tracked within a data system. The Incumbent acts as a resource to SIU Healthcare and SIU School of Medicine (FQHCs) In planning for new clinics and expansion of services and service area. This position works with administration in the oversight and management of SIU Healthcare and SIU School of Medicine (FQHCs} credentialing team.

Examples of Duties

The following information is intended to be representative of the work performed by the 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 or related to a logical extension of position responsibilities.

Demonstrate by actions, commitment to the mission and behavioral standards of the 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.

Supervision 50%

• Provides direct day to day supervision to the Credentialing team.
• Assists in the training of the Credentialing staff and related support staff.
• Evaluates the work performance of the Credentialing team.
• Plans, organizes, and directs the activities of credentialing staff in support of the duties and responsibilities outlined by the Director.
  
  

Credentialing Administrative Duties 25%

• Works closely with the clinical departments, human resources and external institutions to establish and administer the credentialing, privileging, reappointments, Medicare, IL Medicaid and health plan enrollment processes.
• Develops capacity for SIU Medicine to assume delegated credentialing with major health plans, reviewing requirements, and assuring compliance with those requirements.
• Works with Office of Human Resources (OHR) to coordinate provider onboarding for employment.
• Oversees processes for Credentialing staff.
• Assists in executing processes for staff who manage the process of procurement of DEA, licensure and malpractice insurance information.
• Works directly Risk Management and Office of Legal Counsel to evaluate and provide malpractice insurance.
• Oversees processes for staff who work with partner hospitals to granting of expedited and non-expedited hospital privileges.
• Establishes and maintains network and relationship of key contacts with health plan representatives to encourage delegated and/or expedited credentialing.
• Prepares for and attends all payor meetings, in person or virtually depending on invite.
• Responsible for delegated credentialing payor audits
• Evaluates, develops, implements and maintains continuity of third-party standards (i.e., CMS, IL Medicaid, NCQA, etc.}. providers. Provide interpretation to providers and other internal staff regarding these standards.
• Communicates effectively with leadership, peers and staff on providers to meet the mission and vision of SIU and to promote a satisfying work environment, often dealing with complex and confidential issues.
• Keeps Senior Director, Patient Business Services, as well as department staff, informed as to progress of information gathering. Works to resolve deficiencies.
• Act as lead for maintaining SIU's NCQA accreditation, review NCQA standards and assuring compliance with any new or updated standards.
• Act as lead for the other Medical Staff Service Specialists, managing work distribution, work flow and special projects.
• Coordinate time off for the team and schedule any overtime as approved by Director, Managed Care & Credentialing 16. Provide probationary and annual Medical Staff Service Specialists' evaluations
• Responsible for coordinating, facilitating and presenting and Credentialing Committee.
  
  

Clerical Duties 25%

• Compose communications containing confidential or sensitive information as needed, which very often require in depth knowledge of credentialing and enrollment requirements and procedures.
• Drafts and documents, memoranda, informational notices to health plans, and special project reports out of MD Staff or Microsoft Office.
• Supervises the maintenance of computerized credentialing database.
• Routinely meet with HR and clinical departments to assist and streamline onboarding, initial and re-credentialing for their specific providers and locations.
• Routinely meet with Patient Business Services (PBS) to assist in resolving credentialing related AR deficiencies.
  
  

Qualifications

• High school diploma or equivalent.
• Any one or combination totaling two (2) years (24 months) from the categories below:
• College course work 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)
• 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.
• Two years (24 months) months of work experience comparable to that of the Medical Staff Services Specialist II of the series.
  
  

SKILLS AND ABILITIES NEEDED FOR POSITION

• Effective customer service and organizational skills
• Knowledge and ability to use various computer applications (Proficient in Microsoft Office)
• Exceptional oral and written communication including the ability to make oral presentations and prepare concise reports
• Attention to detail and high level or confidentiality
• Knowledge of National Committee for Quality Assurance (NCQA), federal, state and other regulatory requirements for healthcare providers
• Ability to problem solve and work as a team member
• Sensitive to the needs of underrepresented minority populations
  
  

Out of State Applicants that apply to Springfield vacancies in classifications in the occupational area of Professional, Semi-Professional, or Managerial will be subject to the following Condition of Employment: Pursuant to the State University 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. This should be listed in the Minimum Qualifications for these vacancies.

Supplemental Information

If you require assistance, please contact the Office of Human Resources at [email protected] 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 . 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.