Quality/Credentialing Clinic Services- Medical Staffing (1.0FTE) in Watertown, WI at Watertown Regional Medical Center

Date Posted: 8/15/2019

Job Snapshot

Job Description

Watertown Regional Medical Center

Functions as a change agent and leads Watertown Network office managers to bring about process improvements and to assure best practices are developed; resulting in quality patient care and improvement in financial performance of the PHO as a whole.

Develop and maintain positive relationship with PHO insurance quality representatives. Communicate directly with insurers to receive patient data and spreadsheets related to quality initiatives. Disseminate and share information, questions, answers and solutions with Watertown Network office managers.

Perform Hospital credentialing/re-credentialing functions, completing forms, sending notifications, obtaining and maintaining information in a timely manner as it relates to credentialing and quality information.

ESSENTIAL FUNCTIONS

Schedule, plan, and establish agendas and talking points for Network Quality and Credentialing Committee, Network Quarterly Provider meeting and Network office manager meetings. Ensures that accurate minutes are taken at each meeting, shares those in a timely manner and assists with permanent filing of minutes. Responsible for annual PHO credentialing audit.

Work collaboratively with the IT programmers who will implement the coding for larger clinical projects.

Provide written reports and results appropriate for distribution to Watertown Network Board of Managers, clinic managers and providers. Present data at meetings attended by board, physicians and senior leadership.

Develop a thorough understanding of the Watertown Network computing environment including the data model, file structure and field content.

Acts as a contact for queries and obtains additional information for PHO insurers, providers and their clinics in a timely manner.

Communicates with clinics and business office to ensure registration and billing information is up to date for all payers.

Timely and accurately, responds to all requests for information related to insurance credentialing for PHO. Submit and maintain all required reports per delegation agreements on a monthly, quarterly, semi-annual and annual basis.


Job Requirements

Bachelor’s degree in nursing, health care administration,health care coding, social sciences, statistics, mathematics, or relatedanalytical field, preferred.

Two years of analysis/statistical experience required, ina healthcare related field

Required Skills

Licenses: A valid driver’s license, a reliable personalvehicle and insurance are required.

Requires critical thinking skills, decisive judgment andthe ability to work with minimal supervision. Must demonstrate a high level ofattention to detail.

Requires strong Excel knowledge. Must demonstrate amastery of Excel spreadsheets and basic macro language.

Must demonstrate an ability to manage multiple projects.

Must be able to provide leadership and strongdecision-making and problem solving skills.

Must exhibit strong organizational and communicationskills. Must be able to work under pressure and meet deadlines.

Requires an ability to participate effectively incross-departmental/clinic teams. Clinical experience and/or knowledge of healthcare systems preferred.

Initiates work assignments independently little to nodirection.

Demonstrates responsibility and accountabilityaccording to legal, ethical, professional, educational, and personaldevelopment goals.

Equal opportunity and affirmative action employers and are looking for diversity in candidates for employment: Minority/Female/Disabled/Protected Veteran

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