Provider Data Manager – Medical Staff Services Job Number: 00122275
Job Posting : Oct 9, 2018, 7:48:30 PM Closing Date : Oct 24, 2018, 4:59:00 AM Full-time A.M. P.M.
Posting Salary : COMPETITIVE SALARY
Organization: Health and Hospital Systems
L OCATION: John H. Stroger Hospital – Medical Staff Services
The Provider Data Manager is responsible for maintaining the integrity of information in the credentialing database to support all of the Medical Staff Services Department's functions as well as compliance with the Cook County Health & Hospitals System (CCHHS) managed care contracts. Under the leadership of the Director of Medical Staff Office, the Provider Data Manager monitors, reviews, enters, and validates data. Merges data from a variety of sources and cleans the data for reporting purposes and all National Committee for Quality Assurance (NCQA) roster and compliance requests. Prepares reports using database reporting writing tool as well as development of reports to meet internal and external reporting requirements. The Provider Data Manager is responsible for supplying all files identified for ongoing delegation and/or audits with managed care contractors.
· Produces reports to audit accurate data entry into the practitioner database in compliance with established standards by reviewing, correcting, merging, entering, and modifying, deleting and/or reentering data from various systems.
· Resolves discrepancies by using standard procedures and returns incomplete documents to appropriate sources for resolution.
· Assesses database work flows to develop hospital system processes and procedures to ensure continuous quality improvement and survey readiness.
· Extracts, summarizes and compiles data for internal and external reporting requirements.
· Maintains a report of all adverse actions, terminations for mandatory reporting.
· Develops and manages standard set of reports and works with the CCHHS credentialing software vendor, to produce medical staff reports
· Provides feedback to appropriate support staff in regards to incomplete, inaccurate or inconsistent practitioner information to maintain accurate information in database.
· Manages the development of practitioner letters and tools for credentialing teams to ensure efficient and electronic functionality for all departmental responsibilities.
· Meets on-going deadlines and schedules required for reporting to managed care plans as part of delegated contracts.
· Troubleshoots data concerns between departments, CCHHS Hospital Information Systems (HIS) team and software vendor.
· Manages communication of CCHHS provider changes to all managed care payers.
· Manages development of CCHHS Provider Lookup tool ensuring timely additions and deletions of appropriate staff.
· Performs other duties as assigned.
· High School Diploma and Seven (7) years of experience working with database management systems and tools OR a Bachelor's degree and Three (3) years of experience working with database management systems and tools
(official transcripts required at time of interview)
· Two (2) years of experience with government and commercial managed care provider and facility contracting.
· Two (2) years of experience with National Committee for Quality Assurance (NCQA) audits and surveys related to delegated credentialing.
· Prior report writing experience with Crystal and/or Access
· Intermediate proficiency in Excel
· Certification as a Web-based Credentialing Software User
Knowledge, Skills, Abilities and Other Characteristics
· Excellent communication skills, telephone skills, ability to build rapport with practitioners and other professional staff
· Strong interpersonal skills to handle sensitive situations and confidential information.
· Strong interpersonal skills and the ability to communicate effectively with physicians, administrators, and CCHHS departments/staff throughout the health system.
· Ability to work independently and determine work priorities.
· Ability to learn and implement medical staff services policies and procedures, as well as accrediting and regulatory standards.
· Ability to resource information from others to identify potential problems when collecting data, establishing facts, drawing conclusions and problem solving
· Attention to detail and accuracy
When applying for employment with the Cook County Health & Hospitals System, preference is given to honorably discharged Veterans who have served in the Armed Forces of the United States for not less than 6 months of continuous service
To take advantage of this preference a Veteran must :
Meet the minimum qualifications for the position.
I dentify self as a Veteran on the employment application by answering yes to the question by answering yes to the question,
The Cook County Health & Hospitals System’s mission is to deliver integrated health services with dignity and respect regardless of a patient’s ability to pay; foster partnerships with other health providers and communities to enhance the health of the public; and advocate for policies that promote the physical, mental and social wellbeing of the people of Cook County. CCHHS is comprised of two hospitals, John H. Stroger, Jr. Hospital and Provident Hospital, a robust network of more than a dozen community health centers, the Ruth M. Rothstein CORE Center, the Community Triage Center, the Cook County Department of Public Health, Cermak Health Services, which provides health care to individuals at the Cook County Jail and the Juvenile Temporary Detention Center, and CountyCare, a Medicaid managed care health plan.The system cares for more than 300,000 patients each year and its physicians are experts in their fields, committed to providing their patients with comprehensive, compassionate and cutting-edge care. Today, CCHHS is transforming the provision of health care in Cook County by promoting community-based primary and preventive care, growing an innovative, collaborative health plan and enhancing the patient experience.