TITLE: Provider Data Manager
GRADE:
FAMILY:
JOB DESCRIPTION
Data Mgr
JOB CODE:
9
GL SUB ACCT:
Exempt
8301
SALARY
60002
FLSA:
EEO CODE:
22
PCM
DATE: 3/28/2006
JOB
LEVEL:
I. Position Summary:
Responsible for Medical Staff Credentialing and Privileging, insurance credentialing for 3040 insurance carriers and re-certification every two years
for the insurance carriers, assisting with Physician practice start up, coordinating patient
satisfaction survey process and data collection for Quality
8301 / Provider Data Manager
Job Description.rpt
Committee, Medical Executive Committee and other INTEGRIS Health management
committees. Responsible for ensuring all credentialing and privileging
processes are in compliance with JCAHO standards. Performs other duties as assigned.
II. Essential Functions:
(Core Functions - 75% of time spent)
* Implementation and management of Premis credentialing software program, including
ongoing management of the process to include: Coordination of Medical staff credentialing
information; Verification of training, work history, references, licensures, malpractice history
and all government reporting agencies.
* Prepares Medical Staff records for appointment and reappointment of medical staff
privileges for 80 physicians. Works with Physicians and Clinic
Manager to secure necessary documentation needed for additional privilege requests.
* Works with Quality Manager on provider information for quality and peer review audits.
Prepares documents to be presented to Medical Operations
Committee for approval.
* Works closely with other INTEGRIS departments in coordinating information for
credentialing and privileges necessary for patient care.
* Trains new business office managers on the financial aspects of their position, and daily
clinic operations.
* Provides training to graduating Residents in the Great Plains Residency program for
obtaining: unique physician identification numbers (UPIN), DEA
8301 / Provider Data Manager
Job Description.rpt
Certificates, and privileging criteria for private practice.
* Acts as a resource for physicians, managers and other administrative staff of the MSO for
operational issues.
* Manages the day-to-day operations of the MSO Operations office, including paying bills,
fielding complaints from patients and others; and assisting
Director of Operations and Vice President IPS with projects.
* Participates in preparation for JCAHO review, including survey of sites during Mock
Surveys.
* Manages department specific projects, including tracking medical supplies for 80 physicians
at 17 sites to ensure Novation pricing according to VHA
guidelines and managing the accounts receivable overview reports for 60 + physicians at 12
sites.
* Participates in development of Operations Policy and Procedure for INTEGRIS Physicians
Services.
* Works closely with Physicians and Clinic Managers to gather information necessary for
verification.
* Coordinates insurance contract credentialing for each physician.
* Relates changes and updates in insurance contracts to the contracting committee.
* Works with physicians billing to assure all correct provider information is available for
claims submission.
8301 / Provider Data Manager
Job Description.rpt
* Works with marketing on physician marketing strategies as related to insurance contracting
information.
* Educates new physicians on the credentialing and privileging process.
* Coordinates the patient satisfaction survey process.
* Prepares quarterly reports to be present to the quality committee, physicians, department
directors, and clinic managers.
* Work closely with clinic managers as a liaison for procurement, payroll and other
INTEGRIS Health departments and/or vendors.
III. Accountability:
(Reports to and accountable for)
Reports to the Director of Operations
IV. Qualifications:
(Minimum education, training and experience, licensure, certification
* Two (2) years of college with five (5) years of credentialing experience required.
* Bachelor's degree preferred.
* Advanced knowledge of computers utilizing the Windows environment and utilizing
Microsoft Word, WordPerfect and Excel required.
* Analytical skills for interpretation and tracking of data and good organizational skill
required.
V. Required Physical Demands:
8301 / Provider Data Manager
Job Description.rpt
Strength (Lift/Carry/Push/Pull) : Sedentary (exerting up to 10 pounds of force occasionally)
Standing/Walking: Occasionally; activity exists up to 1/3 of the time
Keyboarding/Dexterity: Frequently; activity exists from 1/3 to 2/3 of the time
Talking (Must be able to effectively communicate verbally): Yes
Seeing: Yes
Hearing: Yes
Color Acuity (Must be able to distinguish and identify colors): Yes
Strength (Lift/Carry/Push/Pull) : Sedentary (exerting up to 10 pounds of force occasionally)
Standing/Walking: Occasionally; activity exists up to 1/3 of the time
Keyboarding/Dexterity: Frequently; activity exists from 1/3 to 2/3 of the time
Talking (Must be able to effectively communicate verbally): Yes
Seeing: Yes
Hearing: Yes
Color Acuity (Must be able to distinguish and identify colors): Yes
Strength (Lift/Carry/Push/Pull) : Sedentary (exerting up to 10 pounds of force occasionally)
8301 / Provider Data Manager
Job Description.rpt
Standing/Walking: Occasionally; activity exists up to 1/3 of the time
Keyboarding/Dexterity: Frequently; activity exists from 1/3 to 2/3 of the time
Talking (Must be able to effectively communicate verbally): Yes
Seeing: Yes
Hearing: Yes
Color Acuity (Must be able to distinguish and identify colors): Yes
VI. Environmental Conditions:
(Exposure to hazardous risks, work environment conditions)
Frequent exposure with minimum of possibilities of electrical shock due to work inside and
around computer devices and wiring. Exposed to traffic conditions when traveling to/from the
offices of INTEGRIS Physicians Services. Travel may include air travel. Exposed to weather
conditions during travel. Mental and emotional stressors related to deadlines for projects.
Heavy work volume and high degree of accuracy required. May require return to work during
evening and weekend hours to resolve critical problems. Exposure to serious error is always
present. Errors in design, logic, processing procedures, data integrity, data security and system
recovery affect patient care and corporate finance. One seemingly minor error can destroy or
compromise data.
8301 / Provider Data Manager
Job Description.rpt