Healthcare Credentialing and Medical Staff Administrator

Group Health Cooperative of South Central Wisconsin•Madison, WI

8d•Hybrid

About The Position

The Healthcare Credentialing and Medical Staff Administrator is responsible for a variety of activities related to health insurance plan credentialing for the GHC-SCW network facilities and providers, credentialing of GHC-SCW employed providers for outside facilities and health plans, monitoring delegated credentialing arrangements, coordinating the Peer Review and Credentialing Committee, acting as a liaison between GHC-SCW employed providers and medical malpractice vendors, acting as a liaison between GHC-SCW employed providers and outside legal requests (depositions, etc) and coordinating student and medical learner placements in the GHC-SCW Medical Division. The Healthcare Credentialing and Medical Staff Administrator provides coordination, communication, and support to other key leaders and functions within GHC-SCW, such as NCQA accreditation, contracting, and GHC-SCW employed provider on/offboarding. The Healthcare Credentialing and Medical Staff Administrator works under the direction, guidance, and supervision of the Chief Medical Officer.

Requirements

Bachelor’s degree from an accredited college or university in business, health care administration or relevant field is required, or equivalent combination of education and relevant experience.
Minimum of three (3) to five (5) years’ experience working in an administrative support position, customer service or related duties.
Experience in a medical setting is required.
Knowledge of and familiarity with medical terminology required.
Knowledge of and high level of proficiency in the use of Microsoft Office applications including Word, Outlook, Excel and PowerPoint is required.
Knowledge of and/or ability to learn and use computer based applications/software such as electronic time and attendance systems.
Ability to use the Internet to obtain information and conduct research.
Leadership skills and collaboration skills are required.
Outstanding written and verbal communication skills required.
Good verbal communication skills to provide telephone support required.
Good interpersonal skills necessary to deal courteously and effectively with members and staff are required.
Excellent customer service abilities required.
Ability to be culturally sensitive and to work with a diverse community.
Ability to work as a part of a team and collaborate with others to accomplish goals.
Professional manner necessary to deal courteously and effectively with other staff and with the public required.
Ability to be appropriately professional in dealing with providers and providers.
Strong organizational skills, including ability to prioritize, manage multiple tasks and solve problems required.
Ability to work within tight deadlines.
Ability to work with minimal supervision required.
Ability to be flexible and adaptable to changing priorities and assignments.
Must be procedure oriented.
Ability to pay close attention to details and strive for 100% accuracy.
Ability to maintain strict confidentiality regarding company information, staff and patients required.
Ability to use a keyboard extensively required.
Fine manual dexterity required.
Ability to work occasional evening and weekend hours as well as overtime required.

Nice To Haves

Healthcare credentialing experience or knowledge of credentialing strongly desired.
Minimum one (1) year experience performing healthcare credentialing functions preferred.
Certification as a Certified Provider Credentialing Specialist (CPCS) with the National Association of Medical Staff Services (NAMSS) preferred but not required.
Knowledge of or ability to learn National Committee for Quality Assurance (NCQA) and/or Joint Commission on Health Care Organizations (JCHCO) standards preferred.
Knowledge of or ability to learn HIPAA requirements.

Responsibilities

Health insurance plan credentialing for GHC-SCW network facilities and providers.
Credentialing of GHC-SCW employed providers for outside facilities and health plans.
Monitoring delegated credentialing arrangements.
Coordinating the Peer Review and Credentialing Committee.
Acting as a liaison between GHC-SCW employed providers and medical malpractice vendors.
Acting as a liaison between GHC-SCW employed providers and outside legal requests (depositions, etc).
Coordinating student and medical learner placements in the GHC-SCW Medical Division.
Providing coordination, communication, and support to other key leaders and functions within GHC-SCW, such as NCQA accreditation, contracting, and GHC-SCW employed provider on/offboarding.