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Provider Credentialing & Enrollment Specialist

Company: University Clinical Health
Location: Memphis
Posted on: May 27, 2023

Job Description:

Job Type
Who We Are:
As the only independent and physician-led faculty practice plan of the University of Tennessee Health Science Center, University Clinical Health (UCH) offers best-in-class clinical care through a network of 175+ providers across 19 specialties to meet the healthcare needs of the Mid-South community. UCH is a not-for-profit, non-tax-supported group practice and is here to serve the community while providing medical excellence to our patients.
Position Summary:
The Provider Credentialing Specialist is responsible for supporting the credentialing and payer enrollment activities of the University Clinical Health providers through timely, accurate, and compliant data management and ongoing monitoring tasks related to credentialing, re-credentialing, enrollment with insurance carriers.
Key Results Areas:

  • Credentialing: *Performs online primary source verification of NPDB, TN and out-of-state professional licenses, DEA certification; AMA or AOA Profile, National Student Clearing House, board certification, or other required online verifications as needed
    *Updates credentialing data in Cactus as required for regular compliance o Runs monthly expirable list and performs associated primary source verification updates, as applicable (licenses, board certificates, DEA)
    *Manages sensitive credentialing information with a high degree of confidentiality and security
    • Enrollment: *Assists team members in the provider enrollment process as requested.
      *Accurately enters provider enrollment data upon receipt of UCH credentialing or updates data in Cactus upon receipt of re-credentialing application
      *Enters payer assignments and effective dates in the Cactus software
      *Maintains internal provider enrollment and responds to verification requests from payers.
      *Performs other duties as assigned.
      Core Competencies:
      • Strong organizational, critical thinking, and problem-solving skills
      • Working knowledge of payer enrollment standards
      • Ability to develop and maintain effective working relationships
      • Strong customer service orientation
      • Excellent interpersonal, written, and verbal communication skills
      • Ability to be detail-oriented in a fast-paced environment Requirements
        Education & Experience :
        • 3-5 years credentialing and enrollment experience required
        • Associate's degree in health care or business preferred
        • Credentialing software required, Cactus software preferred
        • Intermediate to expert working knowledge of Word, Excel, and Adobe imaging software Physical Requirements:
        • Must be able to lift up to 15 pounds at times.
        • Prolonged periods sitting and working on a computer to complete necessary data management
          Effective November 1, 2021, UCH requires all employees to be fully vaccinated against COVID-19 (or have an approved medical or religious exemption from UCH). Please note that a job offer is contingent on submitting proof of COVID-19 vaccination or UCH approval of a medical or religious exemption request. Employees with approved exemptions will be required to undergo weekly COVID-19 testing at an assigned UCH testing location and time.
          EOE-University Clinical Health provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability status, protected veteran status, genetic information, or any other characteristic protected by federal, state, or local laws. University Clinical Health is a VEVRAA Federal Contractor - priority referral Protected Veterans requested.

Keywords: University Clinical Health, Memphis , Provider Credentialing & Enrollment Specialist, Other , Memphis, Tennessee

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