Systems Specialist

FLSA Status

Job Role Summary

The Systems Specialist provides analytical expertise in all system related issues within Medical Staff Affairs and externally with other hospital systems that maintain practitioner data.  They are also responsible for ensuring the timely completion of applications for initial appointment and reappointment by assisting the applicant in submitting all documentation necessary to process the application.  This individual performs a variety of credentialing/re-credentialing tasks to complete the credentialing process.  This position is an integral part of the credentialing team and is responsible for following credentialing policies and procedures, Medical Staff Bylaws, department rules and regulations, medical staff policies, maintaining an accurate practitioner database, collecting and analyzing data, and participating in development and implementation of any regulatory or accrediting agency changes.  

Essential Functions and Responsibilities

•    System management of CACTUS and AppCentral/iPrivileges/iProfile/iResponse.  Establishes user/system security.  
•    Monitors LEMM and the Medicare/Medicaid exclusions list. 
•    Develops and analyzes reports of all sizes and complexity.  Provides instructions to customers, staff, and applicants and members on the processes and utilization of the products. Performs system user training and mentoring on use of the systems and software products.  Manually maintains. CACTUS for all Graduate Medical Education providers and all billable ancillary providers.
•    Maintains all Graduate Medical Education trainees in CACTUS.  Monitors pager, license, and DEA numbers for updates.
•    Epic liaison for provider related issues.  Add and maintain a separate address for every provider within CACTUS for Epic to ensure e-prescribing, proper test results routing for external providers, meaningful use requirements, etc.  Add all managed care PCPs to CACTUS for claims processing and maintain the records.  Works with scheduling and registration throughout the system to add all referring (external) providers not in Epic and maintain the records.  Verifies address, phone, and fax number for external providers and managed care PCPs added to CACTUS.  Responds to and resolves Epic issue tickets submitted regarding providers, the interface, and CACTUS.  Works routinely with Epic Security on SER and EMP records, mapping, duplicate SER records, access, etc.  Works with Epic’s charge router analyst to ensure tax IDs are correct for proper charge routing.  Works with the lab to resolve patient test results routing errors, edits provider(s) in the patient chart.   
•    Creates a provider file meeting HealthStream’s specifications for import into the system and notifies new providers of HealthStream access information.  
•    Manages applications, verifies credentials, monitors various industry databases for evidence of potentially adverse information, red flags potentially adverse information for medical staff leadership review, and identifies areas where practitioners may not meet privileging or membership criteria.  Ensures that the findings, conclusions, and recommendations for actions are reported through the appropriate Medical Staff committee(s) and the Board of Trustees, or appropriate leadership, and that approved actions are then assigned and/or implemented in a timely manner.
•    Contacts various primary sources to gather the required verifications to complete the application.  Provides frequent updates to the applicants, Service Chiefs, and liaisons regarding file status.
•    Prepares written documentation of all verifications including a summary of all verified references and analyzes information thoroughly to identify potential quality of care issues, behavioral problems, and appropriate education and training.  Investigates issues of concern and presents findings to the Director of Medical Staff Affairs.
•    Obtains information from the National Practitioner Data Bank and a criminal background check.
•    Maintains protocols and processes to assure integrity and confidentiality of the data.  
•    Analyzes the integrity of documents scanned internally and externally, imports documents, and ensures accuracy of the imports.
•    Provides resources to MSO leaders to assist them in carrying out their responsibilities.
 

Job Requirements

•    Associate’s degree in computer science/technology/programming and/or minimum of two years of database management experience, preferably CACTUS.
•    Minimum of three years of experience in a business office setting, preferably in health care environment.  Experience working as a Medical Staff professional is preferred.
•    Experience with the CACTUS database is preferred.
 

Knowledge, Skills & Abilities

•    Knowledge of credentialing and privileging.
•    Critical thinking and analytical skills.  Exceptional organizational skills.
•    Experience in database management.
•    Ability to work strategically in identifying the priorities of the Medical Staff Affairs Department.
•    Ability to form collaborative relationships.  Effective and responsive interpersonal skills, e.g., capable of gaining immediate credibility with individuals through experience, presentation, and communication skills.  Experience with effective conflict resolution skills.
•    Communication skills, verbal and written, which include the ability to document in detail the work and verbally provide direction, explanation, and analysis.
•    Computer skills to include database, Microsoft Office, and use of internet services.