Director of Managed Care Operations (Temporary) (5532)

About the role

Experience and familiarity with SIU Medicine’s payer contracts, reimbursement arrangements, credentialing operations, and key payer relationships will help prevent delays that could negatively affect provider participation, patient access, billing, and revenue. This temporary support will also ensure that time-sensitive contract negotiations, renewals, credentialing matters, and payer issues continue to be addressed until a permanent replacement is hired and successfully transitioned into the role.

Responsibilities

• Provide interim support for managed care contracting and provider credentialing, including assisting with payer contract negotiations, renewals, implementation, and issue resolution.
• Monitor reimbursement and contract performance.
• Support payer enrollment, credentialing, recredentialing, and hospital privileging activities.
• Help maintain continuity of critical operations until the position is permanently filled.
• Assist with cred committee and answer questions from staff.
• Handle managed care and payer issues.
• Assist with analysis for an ongoing payer negotiation and answer questions around processes.

Requirements

Condition of Employment: Pursuant to the State Universities 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.

Qualifications

• 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.
  • Six (6) months of work experience comparable to that of the Medical Staff Services Specialist I of the series.

Skills

• 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 learn and utilize Medical Staff credentialing software and other information technology-related work products.
• Ability to learn and apply the content of Medical Staff Organizational Documents.
• Ability to learn and 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 in response to new information or changing circumstances.