PURPOSE OF POSITION: Responsible for provider enrollment with core payors; responsible for maintaining and updating all appointees' expirables using data base management skills: To provide support and analyze data in the reappointment process. Utilize and maintain CAQH applications for employed providers. Implement and maintain moderately complex computer-based systems associated with the medical staff.
Enter payors in the provider's computer profile. Send enrollment applications to commercial and state payors. Work as a liaison between the payor and provider. Send applications to appropriate hospital divisions/providers for signature. Contact representatives from commercial payors, state Medicare/Medicaid, and hospital divisions via e-mail or telephone to check enrollment status of providers. Update in computer database the expected date the application is to be returned by state payors and by hospital divisions. Identify and resolve enrollment issues with third party payors as well as maintain providers' eligibility with contracted payors.
Coordinate, perform and track required expirables e.g. licensure, DEA certificates, TB testing, annualinfluenza, specialty boards (MOC), advance life support and malpractice information for all appointees according to established law, policies and procedures. Establish and maintain providers' eligibility with core payors with regards to updated licensure information. Monitor information collection. Perform cognitive analysis of all information received; evaluate adequacy and quality, pursue additional information as needed. Serve as liaison between contracted payors and Cincinnati Children's departments/divisions.
Coordinate, enter and maintain information for all employed appointees in the CAQH application. Information includes but is not limited to education, specialty and board certification, licensure, practice locations, and malpractice information.
Provide support in obtaining required information for reappointment of the medical staff and allied health professional staff according to established law, policies and procedures. Analyze information obtained to determine if further action is required.
UPIR Database (As of 11/19/15 Referring Database)
Coordinate, perform and track information regarding referring physicians, residents, fellows, APNs/PAs and appointees of the medical staff according to established law, policies and procedures. Monitor
information collected. Perform yearly audit to determine providers are still licensed practitioners.
Serve as liaison between house staff, graduate medical education, scheduling center, information services and physician services.
Customer Service & Development
Respect patient/medical staff rights for informed consent and the handling of confidential information. Review timeliness, accuracy, availability and security of information. Participate in improving
organizational performance through recommending areas or approaches for improvement activities, performing new procedures, collecting data and providing input to department discussions. Understands, adheres to
and models Cares Standards as defined organizationally and specifically within the department.
Telemedicine and Delegated Telemedicine Credentialing Agreements
Responsible for completing required documents/applications for credentialing CHMC providers at non-CHMC facilities who are providing telemedicine services. Responsible for collecting required documentation and completion of required documents for CHMC providers where there is a delegated credentialing agreement in place for telemedicine services.
SKILLS and COMPETENCIESAccountability
Taking responsibility for one's actions and work; accepting the consequences of one's behavior; admitting mistakes.
Pursing work with little supervision or assistance; directing one's own efforts.
Presenting written and oral information in an accurate, clear, succinct, and understandable manner using correct grammar, and logical flow of ideas; adapting communication style and tone to fit the situation and engage the audience.
Using inductive and deductive reasoning to formulate general rules or principles and apply them to work; identifying flaws in logical reasoning; understanding complex conceptual relationships; accurately detecting underlying themes or patterns in data.
Identifying the optimal solution using principles of evidence-based practice to integrate best practice, research, evidence, and job, organization, and/or industry expertise with the needs and requirements of the patient, family and/or situation.
Meticulously keeping track of details without becoming overwhelmed by them; being exacting, precise, and accurate; spotting minor imperfections or errors and taking action to correct them.
Being open to change and considerable variety in work activities; effortlessly adjusting to new or changing situations and unexpected events; altering one's approach to tasks and projects with minimal loss of efficiency.
Believing good things are likely to happen and that one's actions will result in positive outcomes; demonstrating optimism in all circumstances; avoiding cynicism and remaining hopeful; believing the best of people and one's circumstances; demonstrating satisfaction at work.
Remaining composed and calm when faced with setbacks, disappointments, rejection, crises, stress or pressure; readily putting aside concerns to get the job done; taking a problem solving rather than an emotional approach when faced with a difficult situation; being even-tempered and non-defensive.
Consistently honoring promises, fulfilling obligations, and meeting deadlines; working hard to conscientiously and thoroughly complete work; pushing oneself to successfully continue working on a task in the face of obstacles or setbacks; working continuously and intensely over long periods of time
·Bachelor's Degree in a related field OR
·4 years related experience in a healthcare environment Preferred:
·Eligibility to sit for the CPMSM (Certified Professional Medical Staff Management) or CPCS (Certified Professional Credentialing Specialist) exam through the National Association of Medical Staff Services (NAMSS).