Information System Specialist - managed Care Enrollment

UNC Health Care Systems Chapel Hill, NC
Position: Information System Specialist

Location: Hedrick Building, Chapel Hill

Hours: Full-time, 40hrs, Monday-Friday

This position may involve support of various hospitals and health care systems within the UNC Health Care System, but will be employed by Rex Hospital, Inc. (this includes, but is not limited to, for purposes of payroll, health benefits, retirement options, and applicable policies). If selected candidate is currently employed with UNC Health Care System the candidate will stay on current payroll and benefits platform.

UNC Physicians Managed Care Provider Enrollment Department and UNC Hospitals' Office of Medical Staff Services jointly maintain a credentialing/provider/managed care database known as ECHO, which contains key information for all facilities, UNC physicians and community physicians affiliated with UNC Health Care. This information is vital to insurance payers recognizing our providers and facilities as contracted in-network providers and facilities. This critical first step in the overall revenue cycle process is necessary to enable contracted payers to pay all of our professional staff and facilities properly under the terms of our payer agreements.

This position is responsible for maintaining the database and associated processes necessary to ensure each UNC provider and UNC facility is properly enrolled with insurance agencies and is accurately represented in internal and external payer databases. Delays or misrepresentation could impact patient visits, clinical productivity, and correct claims processing. The position must take a lead role in working with the Office of Medical Staff Services, Clinical Departments, Practice Administrators, Revenue Cycle, and health insurance credentialing departments to ensure the accuracy of the provider and facility data. This position is responsible for preparing and submitting monthly provider rosters to the insurance payers, auditing online provider directories for accuracy and preparing other ad hoc reports as needed. This position will also be responsible for researching and resolving any discrepancy with a provider or facility credentialing status that may affect correct claims processing or patient care and identifying root causes of database/system-related errors.

This position is responsible for completing facility credentialing applications, preparing service site lists and procedure code lists as needed, auditing facility data for accuracy and other ad hoc reports as needed. The position must manage all credentialing related documentation and ensure the information meets federal and state guidelines.

Candidate must have experience with Excel and would prefer experience with Business Objects. Candidate must demonstrate excellent communication, organizational skills, ability to manage multiple tasks, and establish and maintain effective working relationships with internal and external stakeholders.

Requires Bachelor's degree in Business Administration, Information System Management or a closely related field and one year of experience in the management of a data system; or an equivalent combination of education, training and experience.

If an Associate's degree: Five (5) years of experience in data system management.

If a High School diploma or GED: Nine (9) years of experience in data system management.