The Med Staff Administration Specialist directly impacts the financial stability of the Company because he/she is the SG representative who coordinates the provider number approval process. The Med Staff Administration Specialist, using his/her knowledge of Schumacher Group policies in conjunction with insurance carrier credentialing and enrollment requirements, facilitates provider enrollment and billing privileges on behalf of all Schumacher Group applicants through coordination of insurance plan enrollment and credentialing activities among various parties, including the Provider, Regional Operations staff, Insurance Carrier and Billing Company Representatives. Through effective, efficient and timely provider enrollment and standard Agreement processing the Med Staff Administration Specialist directly impacts Company-identified key objective areas: Service, People and Business that are essential to providing excellent medicine for our patients.
Demonstrates behavior expected of a professional member of the organization, including but not limited to:
* Standard Provider Agreement Processing
* Completes Agreement tasks within one business day of receipt. Agreements will be sent to applicants using Echo Sign.
* Provider Enrollment
* Process Medicare, Medicaid, Tricare and BCBS (others as required) applications simultaneous to hospital privileging process:
* Provider's Liaison to Billing Company on enrollment and claims related issue
* Follow-up with insurance plans to secure provider approval through provider number (PIN) assignment. Enter approval information into Sales Force so billing company can be notified to release claims.
* Follow-up with insurance plans to address and resolve claims denial issues related to provider enrollment.
* Managed Care Department Interaction
* Med Staff Administration Specialist has access to confidential and protected patient information and must handle sensitive information in accordance with SG protocol and HIPAA rules and regulation.
* Monitor carrier website for forms revision and update master provider enrollment packets as needed
* Advise management of issues with carriers/problem providers
* Answer incoming calls in a professional manner
* Maintain clear and concise Agreement and Enrollment files both in paper form as well as Sales Force
* Maintains a high degree of ethics, integrity, and confidentiality in dealing with employees, and external customers.
* Performs other duties as required and assigned
Bachelor's degree (B.A.) from a four-year college or university, one to two years related experience and/or training or equivalent combination of education and experience required. Knowledge of Joint Commission and/or NCQA credentialing requirements is preferred, but not required.
Registered Health Information Administrator (RHIA), Certified Professional Medical Services Manager (CPMSM) or Certified Provider Credentials Specialist (CPCS) certifications are helpful and encouraged. SG promotes the attainment of the CPCS and CPMSM certifications as they are viewed by Industry Professionals as individuals who are knowledgeable about the Credentialing process.
High Skills: Possesses critical thinking skills, takes accountability, uses initiative, takes risks, thinks strategically, promotes changes, uses good judgment, seeks guidance as needed and has the ability to define and solve problems, collect data, establish facts and draw valid conclusions.
Schumacher Group - 20 months ago
copy to clipboard