Clinical Operations Sr. Specialist - 2025935

ROLE & RESPONSIBILITIES:

HIPAA Compliance

Coordinate operational HIPAA and health-information compliance activities, including development, review, implementation, and maintenance of related policies, procedures, and staff resources.

Identify privacy, security, or operational compliance concerns and coordinate appropriate follow-up with organizational leadership, IT, and other subject-matter experts.

Develop and maintain staff guidance, training resources, and operational tools related to HIPAA, EHR systems, Medicaid/MCO processes, and other assigned systems.

EHR, Medicaid & Managed Care Administration

Coordinate the configuration, maintenance, and ongoing improvement of the EHR, including forms, templates, permissions, workflows, service configurations, and administrative processes.

Coordinate Medicaid billing-system configuration and workflows in partnership with Finance, billing resources, EHR resources, and clinical leadership to connect service documentation with billing systems, support accurate billing, resolve system barriers, and improve processes.

Develop proficiency in billing processes and systems to provide backup billing support during staff absences, periods of increased workload, or other operational needs.

Coordinate Medicaid MCO administrative requirements, including contracting, applications, renewals, recredentialing, implementation, and required organizational documentation in collaboration with leadership and other responsible departments.

Maintain required Illinois HFS Behavioral Health Clinic enrollment and coordinate operational documentation and systems readiness for HFS, Medicaid, MCO, and other applicable administrative reviews.

Oversee and coordinate systems and clinical audit requests, ensuring required information and documentation are gathered and responses are facilitated in a timely manner.

Monitor changes in Medicaid, HFS, MCO, and related operational requirements and coordinate necessary updates to systems, workflows, procedures, and staff resources.

Coordinate provider Medicaid enrollment, credentialing, and recredentialing, and maintain systems for tracking clinician licensure, renewal requirements, and continuing education documentation.

SharePoint & Systems Administration

Maintain and improve SharePoint sites and operational resources so current forms, procedures, guidance, and tools are accessible to staff.

Maintain systems onboarding, role-change, and offboarding processes, coordinating appropriate access to EHR, Teams, SharePoint, billing platforms, and other systems.

Create and maintain standardized forms, permissions, and system workflows across programs and locations.

Identify opportunities to simplify administrative systems, reduce duplication, and improve coordination between program, administrative, and clinical teams.

IT, Vendor & Operational Coordination

Serve as the primary operational liaison with IT, managed service providers, and other designated technology or systems partners to address technology, access, privacy, and operational needs.

Track technology and systems issues, coordinate resolution, and implement approved changes affecting the Microsoft suite and the EHR.

Maintain documentation of key systems, configurations, access processes, workflows, and operational procedures to support continuity and cross-departmental coordination.

Coordinate with Data and program leadership to support reliable system configuration, data workflows, and reporting infrastructure for operations.

Provide leadership with timely information about unresolved systems issues, operational risks, and recommended improvements.

Actively participate in department meetings, staff development opportunities, program trainings, community activities, and organizational events.

Other duties as assigned.

JOB REQUIREMENTS:

• Mature and personal Christian faith
• Committed to the mission, vision, and values of World Relief
• Desire to serve and empower the Church to impact vulnerable communities
• Able to affirm and/or acknowledge World Reliefs Core Beliefs, Statement of Faith, Christian Identity and National Association of Evangelicals' For the Health of The Nation document
• Valid drivers license, access to reliable vehicle and ability to pass MVR standards
• 1–3 years of experience supporting compliance activities related to HIPAA, state regulations, insurance contracts, audits, and documentation requirements within healthcare, behavioral health, social services, or similarly regulated programs.
• Working knowledge of HIPAA and health information privacy practices.
• Experience working with electronic medical record systems (or comparable systems) and operational workflows.
• Ability and willingness to learn billing processes sufficiently to provide designated backup support.
• Strong systems-thinking, project coordination, process-improvement, communication, and organizational skills.
• Ability to turn complex systems, compliance, and administrative requirements into practical processes and resources for staff.
• Ability to work effectively with clinicians, program staff, Finance, IT, Data, vendors, billing resources, Medicaid managed care organizations and organizational leadership.

PREFERRED QUALIFICATIONS:

• Bachelor’s degree in healthcare administration, business, public health, health information management, social services, or a related field preferred; equivalent relevant experience may be considered.
• 4–7 years of experience supporting clinical practice operations and compliance, including HIPAA, state regulatory requirements, insurance contracts, audits, and documentation standards within healthcare, behavioral health, social services, or similarly regulated programs.
• Experience with Medicaid billing systems, managed care, Medicaid enrollment, credentialing, or related administrative processes.
• Experience maintaining clinician licensure, Medicaid enrollment, credentialing, or continuing education tracking systems preferred.
• Experience administering or developing SharePoint-based resources and workflows.
• Experience coordinating projects or operational systems across multiple programs, departments, or locations.