UIC Human Resources

UIC Human Resources

Job Details

Medical Staff Services Specialist II - Managed Care UIH (Job ID #142210)
Managed Care
Civil Service
UI Health
05/18/2022
Days
37.5 hours/week

Job Description

The University of Illinois at Chicago, UI Health & Hospital Systems, is looking to hire the ideal candidate to fill the position of  Medical Staff Services Specialist II. Team Members in this role serve as support and resource personnel for centralized Managed Care credentialing services in a health care physician group. They are typically engaged in such services as implementing procedures in accordance with contract payers industry trends, delegated contract credentialing and standard credentialing procedures.

The Medical Staff Services Specialist II will also be involved in provider Health Plan participation by professional medical staff members (physicians, dentists, optometrists, APN, physician assistant, physical therapist, occupational therapist and LCSW) in accordance with institutional policies and managed care health plans policies. The aforementioned involvment may include such activities as verifying applicants credentials, ensuring the completeness of applications, and presenting completed applications and profiles to participating Health Plans.

 

*University of Illinois faculty, staff and students are required to be fully vaccinated against COVID-19. If you are not able to receive the vaccine for medical or religious reasons, you may seek approval for an exemption in accordance with applicable University processes.*

Essential Duties/Responsibilities
 
• Serves as a resource person on managed care credentialing issues, including managed care credentialing processes and medical staff by-laws. Sets up and maintains managed care health plan departmental policies and procedures that meet the requirement of external accrediting agencies and that comply with the medical staff bylaws rules and regulations.
• Provides credentialing information to all contracted payors within established timelines to ensure providers are listed as participating and audits payors systems for accurate claims processing.
• Provides Managed Care credentialing training to the appropriate Clinical College Administrator and assigned credentialing liaison representative.
• Prior experience with a variety of managed care and medical staff  concepts, practices and procedures for credentialing
• Engage and coordinate the request of new/reappointment medical staff credentialing applications with appropriate credentialing liaison to ensure the exchange and collection of needed information.
• Maintains a centralized customized database of approved medical staff members participating in managed care, including complete demographics (degrees, schools, board certifications, NPI, license and expiration dates and current medical staff approval date).
• Manages, maintains, and houses data files (such as confidential managed care profiles and a roster of all managed care participating providers on staff).
• Ensures the completeness of credentialing applications according to the managed care health plans guidelines.
• Communicates with appropriate Credentialing liaison regarding the flow of information necessary to maintain daily activities with the Managed Care Credentialing area.
• Keeps appropriate credentialing liaisons informed with regard to professional medical staff members managed care plan participation
• Audits each managed care contract plan website for medical staff participating providers for accuracy (address, specialty, name and product listing).
• Responsible for updating and maintaining tables in the Epic system associated with claim holds for providers pending enrollment with Managed Care payers. Routinely follows up with payers to reconcile and verify that provider rosters have been loaded within applicable claims systems to ensure timely submission of claims.
• Meet with external credentialing contract managers.
• Attends off site managed care meetings regarding credentialing, quality management projects and educational resource.
• Attends quality management and medical staff services meetings.
• Performs other related duties and participates in special projects as assigned.

Minimum Acceptable Qualifications

CREDENTIALS TO BE VERIFIED

1. possession of requirements listed for the next lower level of this series
2. Any one or any combination of the following types of additional preparation:
           (a) work experience performing duties comparable to those of the Medical                         Staff Services Specialist I
           (b) credit for college course work in office occupations, business                                         education,business administration or closely related fields
           (c)  credit for college course work in health-related fields (such as                                        biology,anatomy, physiology, nursing, medical records, or public health)
                  that totals 1.0 unit according to the following conversion rates:
                                  12 months of "a" = 1.0 unit
                                  12 semester hours of "b" = 1.0 unit
                                  12 semester hours of "c" = 1.0 unit.
 
Amounts of experience and training less than those listed above should be converted to decimal equivalents of 1.0 unit and added together when computing combinations of the different types of preparation.
 
3.12 months of work experience performing duties comparable to those of the Medical Staff Services Specialist I in addition to the training/experience listed in #2 above

4.Demonstrated experience with Managed Care Credentialing payor enrollment required

Find requirements and experience for the next lower level of this series (Medical Staff Services Specialist I) at the link below:

https://www.sucss.illinois.gov/pages/classspec/ViewSeries.aspx?tblCS_SeriesID=390

 
PREFERRED QUALIFICATIONS:
1. Must be proficient in all Microsoft office programs (Access, Excel, Word, Powerpoint, etc.)
2. Strong Analytic Skills
3. Managed Care related experience
4. Customer Services related experience
5. Strong Presentation Skills
6. Strong ability to multi-task multiple projects 
7. Familiar with JCAHO and NCQA in respect to credentialing
8. Familiar with HFS website and completion of Medicaid and Medicare applications process
 

To Apply: For fullest consideration, please fully complete an online application by clicking the Apply for Position button below.

Fully complete all sections of the online application including adding your full work history with specific details of your duties & responsibilities for each position held.

Fully complete the education, licensure, certification and language sections.

You may upload a resume, cover letter, certifications, licensures, transcripts and diplomas within the document section of your online application.

All civil service positions require an exam

You will be required to report in person for this exam. If you are selected to sit for an eaxm, you will be contacted regarding time, date and location of the exam.

When completing your online application, please be sure to provide detailed information about your job knowledge and specific duties and responsibilities, as your qualifications for any Civil Service position will be primarily determined based on what is contained in the application. Dates of employment and if employed on a full or part time basis (including number of hours per week) must be indicated for each position held. Additional consideration will be given to supporting documentation i.e. resume, transcripts, licenses, and certifications so please be sure to attach all applicable documents.

University of Illinois faculty, staff and students are required to be fully vaccinated against COVID-19. If you are not able to receive the vaccine for medical or religious reasons, you may seek approval for an exemption in accordance with applicable University processes.

For classifications that require a degree as part of the minimum qualifications, a degree verification will be required before any offers of employment are extended.

For aditional information regarding this position, plesea contact kbridgey@uic.edu.

If an application is not fully completed and submitted by the close date, the applicant/employee will not be considered for this position.

For fullest consideration, the above mentioned requirements must be submitted no later than Wednesday, May 18, 2022.

We appreciate your interest in employment at the University of Illinois at Chicago. 

The University of Illinois is an Affirmative Action/Equal Opportunity Employer.  

 

 

 

 

 

 

Back to Job Board


The University of Illinois at Chicago is an affirmative action, equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, gender identity, sexual orientation, national origin, protected veteran status, or status as an individual with a disability.


Offers of employment by the University of Illinois may be subject to approval by the University’s Board of Trustees. The University of Illinois may conduct background checks and other pre-employment assessments on all job candidates upon acceptance of a contingent offer. Background Checks will be performed in compliance with state and federal law.

As a qualifying federal contractor, the University of Illinois System uses E-Verify to verify employment eligibility.

The University of Illinois System requires candidates selected for hire to disclose any documented finding of sexual misconduct or sexual harassment and to authorize inquiries to current and former employers regarding findings of sexual misconduct or sexual harassment. For more information, visit https://www.hr.uillinois.edu/cms/One.aspx?portalId=4292&pageId=1411899

University of Illinois faculty, staff and students are required to be fully vaccinated against COVID-19. If you are not able to receive the vaccine for medical or religious reasons, you may seek approval for an exemption in accordance with applicable University processes.