Medical Staff Services Specialist I

Position Summary Under direct supervision, this employee provides specialized support in payer credentialing, re-credentialing, and Hospital privileging functions for University of Illinois College of Medicine Peoria (UICOMP). The credentialing/re-credentialing process requires the management of numerous deadlines set by the Federal Agencies, State of Illinois, hospitals, and insurance payers. This position will enter information into databases such as CAQH, Impact, and internal centralized information database as well as numerous spreadsheets based on insurance payer specifications. The employee serves as a resource for staff from the various internal/external departments, insurance payers, and hospitals to complete the overall process. This position uses independent judgement and problem-solving skills. Duties Responsibilities This position serves as a resource for internal departments, committees, hospitals, insurance companies, Federal agencies, and the State of Illinois. This includes all UICOMP physicians, PHDs, APNs, LCSWs, LCPCs and locum tenens. The position coordinates and verifies completeness all forms and Licensure submitted by the various UICOMP clinical departments. Documentation includes but is not limited to State credentialing forms, board licensure, diplomas, DEA, Controlled Substance, liability coverage, etc. The Medical Staff Services Specialist I communicates with physicians, coordinators and staff with regard to work progress, flow, deadlines, signatures, etc. Submits final documentation for approval at the direction of Medical Staff Services Coordinator ensuring all credentialing and re-credentialing deadlines are met. Assists in review of physician accreditation guidelines to meet reimbursement requirements. Uploads and works within internal software database and maintains existing confidential credentialing books for each provider. The position will access confidential information to complete assigned duties. The position completes the compiling, review, and submission of data required to complete payer spreadsheets. Monitors and tracks the status of all submissions on an ongoing- basis. Removes providers who have terminated the Medical Service Plan in compliance with contractual requirements. Participates in meetings with insurance payers to educate and resolve payment or enrollment issues. As delegated, we will submit Global Access Security Form for all new/terms providers that grant or terminate their access to Epic EHR/Billing software. Performs other duties as assigned. Trains staff as needed.