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University of Utah Health Provider Credential Consultant, Sr. in Murray, Utah

Overview

As a patient-focused organization, University of Utah Health exists to enhance the health and well-being of people through patient care, research and education. Success in this mission requires a culture of collaboration, excellence, leadership, and respect. University of Utah Health seeks staff that are committed to the values of compassion, collaboration, innovation, responsibility, diversity, integrity, quality and trust that are integral to our mission. EO/AA

----Must have at least 2 years of experience in Credentialing to be considered for this position----

This position for use in Health Plans Departments only. This position is responsible for all aspects of the credentialing process including, but not limited to, ensuring healthcare professionals meet all regulatory requirements, maintaining current information for each provider via the provider database or credentialing system and coordinating with systems team for EPIC updates. This position must maintain and manage a credentialing work flow to ensure accurate and timely credentialing of new providers and re-credentialing of existing providers.

Corporate Overview: University of Utah Healthcare is an integrated academic healthcare system with four hospitals including a level 1 trauma center, twelve community health centers, over 1,600 providers, and a health plan serving over 200,000 members. University Healthcare is nationally ranked and recognized for our academic research, quality standards and overall patient experience. In addition to our clinical delivery system, we have a School of Medicine, School of Dentistry, College of Nursing, College of Pharmacy, and College of Health providing education and training for over 1,250 providers annually. We have over 2 million patient visits annually and research grants exceeding $350 million. This position is not responsible for providing care to patients.

Responsibilities

  • Trains new credentialing staff members on the credentialing and re-credentialing of providers.

  • Conducts contract solicitation, maintains relationship and contract performance with selected Primary Source Verification vendor.

  • Facilitates monthly credentialing and three year re-credentialing process for medical and allied health professional staff to ensure compliance with the bylaws and regulatory requirements.

  • Implements process improvements as necessary to increase efficiency while ensuring compliance with bylaws and regulatory requirements.

  • Oversees preparation for and participation in annual audits of the credentialing program.

  • Performs audits of delegated credentialing groups.

  • Creates and manages credentialing policies & procedures ensuring accuracy.

  • Maintains all credentialing documentation and provider updates to ensure reliable, efficient retrieval of information by staff.

  • Analyzes data between provider database and Epic, and reports discrepancies.

  • Maintains data integrity in provider database regarding credentialing information.

  • Assists with completion of special projects as requested by various internal departments or in support of requests from regulatory agencies, contracting agencies or other internal/external organizations.

  • Monitors sanctioned providers on a monthly basis, recording and reporting results to the proper contacts and completing any required follow up actions.

  • Works closely with internal teams to research and resolve questions and claims issues in relation to the credentialing status of providers. Records the issues in Epic, CRM's and JIRA tickets.

Knowledge / Skills / Abilities

  • Knowledge of appropriate credentialing requirements and government regulations related to the establishment and maintenance of credentialing procedures.

  • Ability to perform the essential functions of the job as outlined above.

  • Strong oral and written communication skills to effectively communicate with a broad array of internal and external contacts.

  • Ability to establish and maintain effective working relationships with providers, management and staff.

  • Ability to maintain the confidentiality of all records, discussions, and deliberations relating to credentialing, peer review and quality improvement activities.

  • Detail oriented with strong organizational and research skills.

  • Proficiency with spreadsheets and word documents, and preferably Microsoft Access.

  • Familiarity with NCQA standards and how to apply them.

  • Exhibits excellent customer relations.

Qualifications

Qualifications Required

  • Bachelor's degree in Healthcare or Business Management or equivalency.

  • Four years of related experience with at least two of them in credentialing.

Qualifications (Preferred)

Preferred

  • Certified Provider Credentialing Specialist designation.

Working Conditions and Physical Demands

Employee must be able to meet the following requirements with or without an accommodation.

  • This is a sedentary position that may exert up to 10 pounds and may lift, carry, push, pull or otherwise move objects. This position involves sitting most of the time and is not exposed to adverse environmental conditions.

Physical Requirements

Carrying, Lifting, Listening, Sitting, Speaking, Standing, Walking

EEO Statement

The University of Utah Health Care is an Affirmative Action/Equal Opportunity employer. Upon request, reasonable accommodations in the application process will be provided to individuals with disabilities. The University of Utah Health Care is committed to diversity in its workforce. Women and minorities are encouraged to apply.

Requisition Number 44293
Reg/Temp Regular
Employment Type Full-Time
Shift Day
Work Schedule 7-4
Location Name University of Utah Health Plans
Patient Care? No
City Murray
State UT
Department UIP CST 01H UUHP PROVIDER SRVC
Category Business / Administration

The University of Utah Health Care is an Affirmative Action/Equal Opportunity employer. Upon request, reasonable accommodations in the application process will be provided to individuals with disabilities. The University of Utah Health Care is committed to diversity in its workforce. Women and minorities are encouraged to apply.

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