Responsibilities:

• Execute assigned tasks related to managed care (e.g., provider enrollment and credentialing, claims, payor issues) within own area of responsibility, with limited guidance; address standard requests and queries for timely resolution.
• Coordinate with internal teams to collect information and create relevant documentation (e.g., enrollment and credentialing, claims) & standard reports.
• Provide assistance for resolution of any denials related to contractual, enrollment or credentialing issues in a timely manner.
• Perform other duties as assigned to meet the goals and objectives of the department and institution.
• Maintains regular and predictable attendance.

Minimum Education and/or Training:

• High school diploma/GED required.

Minimum Experience:

• Minimum Requirement: 2+ years of experience (in an academic or research setting, preferred).
• Some experience in healthcare office environment with some understanding of managed care contract and reimbursement models.

Licensure, Registration and/or Certification Required by Law:

• None

Licensure, Registration and/or Certification Required by SJCRH Only:

• None

Special Skills, Knowledge and Abilities:

• Seeks to understand customer needs by asking clarifying questions.
• Prioritizes responses to customer queries.
• Solves routine customer problems as per processes, and seeks guidance, if needed for quick resolution.
• Shows general awareness of relevant regulatory requirements related to own work.
• Understands and supports standard process requirements for compliance within own area.
• Shows some understanding of relevant compliance regulations and it's importance in own area within finance.
• Questions, clarifies, and provides explanations as needed.
• Checks documents and reports for clarity and accuracy.
• Seeks and provides information within and outside team in a timely manner.
• Addresses problems in a structured, logical approach.
• Asks for guidance and tries out new ideas when changes in approach are required.
• Adapts quickly and positively; learns from mistakes.
• Plans around multiple tasks and priorities well within own work.
• Is able to cope with unexpected changes in routine and delivers planned outcomes on time.
• Escalates issues/problems and seeks support in a timely manner.
• Exhibits basic understanding of managed care processes and managed care contracting requirements & tools.
• Performs standard tasks within own area (e.g., documentation, contributing to reports), under supervision.
• Has basic understanding of medical software systems, tools and processes.
• Performs standard tasks (e.g., of data recording and reporting on medical record data management systems), under supervision.

Physical Demands and Working Conditions:

• The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.
• Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
• While performing the duties of this job, the employee is regularly required to stand; walk; sit; kneel, use hands to finger, handle, or feel; and talk or hear.
• The employee must occasionally lift and/or move up to 25 pounds.
• Specific vision abilities required by this job include close vision, depth perception and the ability to adjust focus.
• The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job.
• Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
• The noise level in the work environment is usually quiet.
• An essential function of the job is to be able to comply with all applicable federal, state and local safety and health regulations that would apply to this job.
• The employee must move about the work space to access work surface and shelves, cabinets, drawers, and equipment that are at, below or above the work surface.
• Nothing in this job description limits management’s right to assign or reassign duties and responsibilities to this job at any time as business needs dictate. This job description reflects management’s assignment of essential functions; it does not proscribe or restrict the tasks that may be assigned. The information contained herein is not intended to be an all-inclusive list of the duties and responsibilities of the job, nor is it intended to be an all-inclusive list of the skills and abilities required to do the job.

St. Jude is an Equal Opportunity Employer