Springfield, IL
St. Louis, Missouri
San Francisco, California
Stony Brook, New York
Ithaca, New York
Jamestown, North Carolina
Los Angeles, California
Los Angeles, California
Stony Brook, New York
Posted: 28-May-26
Location: Springfield, IL
Categories:
Internal Number: 5356174
Under the direction of 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 stream lining 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 over all 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 SIUHealthcare 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 with in a data system. The Incumbent acts as a resource to SIUHealthcare 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.
*This position is ON SITE only*
2. Assists in the training of the Credentialing staff and related support staff.
3. Evaluates the work performance of the Credentialing team.
4. Plans, organizes, and directs the activities of credentialing staff in support of the duties and responsibilities outlined by the Director.
- 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 on boarding 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 with Director, 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.}.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.
- Provide probationary and annual Medical Staff Service Specialists' evaluations
- Responsible for coordinating, facilitating and presenting Credentialing Committee.
2. Drafts and documents, memoranda and informational notices to health plans, and special project reports out of MD Staff or Microsoft Office.
3. Supervises the maintenance of computerized credentialing database.
4. Routinely meet with HR and clinical departments to assist and streamline onboarding, initial and re-credentialing for their specific providers and locations.
5. Routinely meet with Patient Business Services (PBS) to assist in resolving credentialing related AR deficiencies.
Credentials to be Verified by Placement Officer
- 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.
- 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:
- Two years (24 months) months of work experience comparable to that of the Medical Staff Services Specialist II of the series.
Knowledge, Skills & Abilities (KSA's)
- Ability to communicate properly and effectively in verbal and written form with various levels of Hospital, College, and Medical Staff.
- Ability to work independently, set work priorities, and determine short- or long-term goals, and strategies to achieve them.
- Ability to utilize Medical Staff credentialing software and other information technology-related work products.
- Ability to apply the content of Medical Staff Organizational Documents.
- Apply knowledge, expertise, sound judgment, and other references and resources as necessary to generate and evaluate solutions and recommendations.
- Ability to apply state and regulatory standards for Medical Staff.
- Maintain confidentiality regarding legal matters, privacy issues, information technology, and data integrity.
- Understand clinical competence evaluation concepts, key functions, terminology, and work products, including evaluation tools and techniques used.
- Ability to adapt behavior and lead, champion, and help others in response to new information or changing circumstances.
- Understand and apply performance improvement concepts.
- Understand budget/finance concepts.
- Understand managed care concepts, key functions, processes, terminology, and work products.
Condition of Employment
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.
