Bargaining Unit: Non Representented - Professional

Rate of Pay: $32.82/hour DOE

Summary

Provides administrative support for managed care activities for the District. Performs a variety of tasks related to credentialing coordination activities for the District including credentialing, re-credentialing, auditing, process development external payer and internal provider rosters and data bases. In addition, provides services to support the Payer credentialing/privileging process for all Multispecialty clinicians.

• Essential Duties and Responsibilities
  Provides re-credentialing support services for hospital. Coordinates review and re-filing of applications with, Credentialing Coordinators, and Chief Financial Officer.
• Assists with conducting an annual update with the health plans to update services and provider exhibits.
• Monitors health plan rosters to assure correct listings of hospital, MSC, and providers on health plan websites.
• Develops and maintains relationships with all managed care plans with which the District contracts. Assists in the resolution of problems with contracted payers.
• Maintains current copies and information regarding MSC clinics licensure and clinical accreditation, with local and state agencies.
• Provides credentialing support services for new providers during Onboarding, office procurement and implementation.
• Provides re-credentialing support services for existing providers, gathers information such as DEA, malpractice policies, etc. for the benefit of MSC, the District and health plans. Able to work accurately in District MD Staff database.
• Monitors contents of application packets to ensure completeness, researching problems that affect timely credentialing and privileging.
• Interfaces with clinicians, Administrators, and hospital and clinic staff regarding the credentialing status of MSC and physicians.
• Establishes and maintains database of credentialing including expirations of licenses, initial and expiration of enrollment, insurances, board certification, liability insurance, etc.
• Work requires the ability to prioritize workload, planning for cyclical as well as daily tasks/events, meeting deadlines, responding promptly to critical organizational issues, and managing the demands of multiple projects very frequently.
• Demonstrates System Values in performance and behavior.
• Complies with System policies and procedures.
• Other duties as may be assigned.

Qualifications
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Supervisory Responsibilities
No supervisory responsibilities.

Minimum Education/Experience
No educational requirement and 6 months to 1 year relevant experience

Required Licenses/Certifications
Valid Driver's License in good standing - Upon Hire

Other Experience/Qualifications

Required:

• Minimum 6 months in medical credentialing and managed care.
• Ability to work independently with minimal supervision.
• Demonstrates strong customer service skills and telephone skills.