Clinical Integration Network Clinical Operations Coordinator - ACO Physician Partners

Thank you for considering a career at Roper St. Francis Healthcare!

Scheduled Weekly Hours:

40

Work Shift:

Days (United States of America)

Schedule: Monday-Friday; 8:00 AM - 5:00 PM

Address: 8536 Palmetto Commerce Parkway, Ladson, SC 29456

Primary Function/General Purpose of Position

Under the guidance of the Roper St. Francis Health Alliance (RSFHA) Director of Operations, the CIN Operations Specialist coordinates initiatives and day-to-day operations of the Clinically Integrated Network (CIN). The Operations Specialist will provide concise and relevant information to the Director to assist in the development and execution of strategies and network development. This position will aid in the support of the RSFHA Board of Directors and its Subcommittees through project management of annual recurring and ad hoc projects (ex. annual network membership reviews, provider compliance with participation requirements, etc.)

Essential Job Functions

Provider Membership Management – RSFHA lead for working with providers to execute and renew participation agreements and addendums as needed. Responsible for maintaining database of participation agreements, provider compliance with participation requirements and provider rosters. Provider roster management includes ongoing capture and verification of all provider info needed to operate online provider search tools, submit rosters for claims processing, manage prioritization of “refer-to” providers in EHR and conduct other important RSFHA business.  

Patient Communications – RSFHA lead for [1] general marketing and [2] individual patient assistance. Responsible for working with RSF Marketing team to develop and execute RSFHA’s annual marketing plan to include patient mailers, annual enrollment materials and other patient-facing marketing materials. Also responsible for responding to individual patient and family member issues, requests, etc. This includes out-of-network waiver review, escalated complaints, complex access issues and other similar needs.

RSFHA Network Management – RSFHA lead assigned to support the RSFHA Professional Standards and Credentialing committee. Responsible for working with committee chair and RSFHA leadership to conduct annual network membership review, review provider participation requirements, manage corrective action process, review network ancillary/wrap providers, etc.

Payor and Employer CIN Operations – RSFHA lead for all employer annual enrollment activities including messaging, presentations and promotions. Responsible for working with RSF Marketing and IS to develop and maintain patient-facing online provider search tools. Responsible for working with payors to submit network rosters and TIN files such that claims process according to RSFHA network status. Responsible for working with payors and employers to address annual review of network structure - wrap network and ancillary providers. Responsible for coordinating and managing waiver process for out of network exceptions.

Ad Hoc CIN Projects – Supports ad hoc CIN projects as needed. Examples include coordination with SNF’s to support post-acute care, coordination of on-site events at client companies, etc.

Provider Communications – RSFHA lead responsible for developing and executing RSFHA’s provider communications plan. Requires regular, ongoing collaboration with RSF Marketing Liaison team.

This document is not an exhaustive list of all responsibilities, skills, duties, requirements, or working conditions associated with the job. Employees may be required to perform other job-related duties as required by their supervisor, subject to reasonable accommodation.

Licensing/Certification

CAPM or PMP preferred.

Education

Bachelor’s degree required, prefer degree in Business, Finance or related field. 

MBA or MHA required.

Work Experience

Three to five years of experience in healthcare administration or project management required.

One to two years of ACO/CIN experience strongly preferred.

Experience supporting large-scale organizational projects preferred.

Training

N/A

Language

N/A

Patient Population 

         Demonstrates the knowledge and skills necessary to provide care appropriate to the age of the patients served on his or her assigned unit.

         Demonstrates knowledge of the principles of growth and development of the life span and possesses the abili