Credentialing Specialist

Paycom - ATS; Salt Lake City (UT); On-site; USD 25,000 - 39,000; Full time

Job summary

Association for Utah Community Health (AUCH) seeks a Credentialing Specialist to maintain provider active status through initial and ongoing credentialing for HRSA, payers, Medicare and Medicaid. You will manage CAQH, PECOS, NPPES entries and renewals, ensuring timely licensure and accurate provider profiles.

In-office responsibilities include collaboration with billing and support teams. Qualified candidates have Utah credentialing experience, strong computer and organizational skills, and

Qualifications

• Knowledge of providers credentialing and its impact on revenue cycle.
• Experience with Utah Medicaid and credentialing processes.
• Experience in behavioral and dental credentialing.
• Proficient with computers including Excel and Word; internet use.
• Must reside in Utah; strong organizational skills and attention to detail.
• Two years credentialing experience preferred; remote credentialing a plus.

Responsibilities

• Maintain provider files with up-to-date information for government and payer credentialing.
• Manage internal provider grid on cloud-based software; ensure access and accuracy.
• Update CAQH files on schedule per CMS requirements.
• Complete credentialing and re-credentialing applications for payers, Medicare, and Medicaid.
• Collaborate with billing staff to resolve denials and authorization issues.
• Maintain provider profiles on CAQH, PECOS, NPPES, and CMS databases.
• Perform other duties as assigned.

Skills

Credentialing knowledge

Utah Medicaid experience

Behavioral & dental credentialing

Computer skills (Excel, Word)

Attention to detail

Customer service

Education

High School Diploma or GED

Tools

CAQH

PECOS

NPPES

Modio Software

Job description

The Association for Utah Community Health (AUCH) is a membership association comprised of Utah’s Federally Qualified Health Centers (i.e., health centers) and allied not-for-profit health care organizations. AUCH is a busy, team-oriented non-profit organization that represents and supports its membership by providing training and technical assistance, policy analysis and services to improve the quality of and access to comprehensive health care services.Organizational Background/MissionFor over 30 years, AUCH has represented Utah's health centers and their patients. As Utah’s federally designated Primary Care Association and Health Center Controlled Network, we provide over 12,000 hours of training and technical assistance to Utah’s health centers and affiliate members each year. Our members provide comprehensive, high-quality primary and preventive health care services to all individuals, with or without insurance, regardless of ability to pay. Health centers are community-based, patient-directed organizations that eliminate geographical and financial barriers and serve populations with limited access to care. In support of our members and the people they serve, AUCH helps reduce barriers to health care through health promotion, community engagement, education, and policy analysis. AUCH receives federal, state, and private program support to improve the quality of and access to comprehensive health care services.Job SummaryThe Credentialing Specialist is responsible for maintaining active status for all providers by successfully completing initial and subsequent credentialing packages as required by HRSA, commercial payers, Medicare and Medicaid.Principle Responsibilities:The following information is intended to be representative of the essential functions performed and is not all-inclusive.• Maintain individual provider files to include up to date information needed to complete the required governmental and commercial payer credentialing applications.• Maintain internal provider grid on cloud-based software platform to ensure all information is accurate and logins are available.• Update each provider CAQH database file timely according to the schedule published by CMS• Apply for and renew annually all providers licenses; Professional, DEA, Controlled Substance• Complete credentialing applications to add providers to commercial payers, Medicare, and Medicaid• Complete re-credentialing applications for commercial payers• Work closely with billing staff to identify and resolve any denials or authorizations issues related to provider credentialing• Maintain accurate provider profiles on CAQH, PECOS, NPPES, and CMS database• Other duties as assignedKnowledge, Skills, and Abilities:• Knowledge of providers credentialing and its direct impact on the practices revenue cycle• Experience with Utah Medicaid• Experience behavioral and dental credentialing• Excellent computer skills including excel, word, and Internet use.• Detailed oriented with above average organizational skills• Plans and prioritizes to meet deadline• Excellent customer service skills; communicates clearly and effectively• Must reside in the State of UtahEducation and Experience Required:• High School Diploma or GED• Two years credentialing experience preferred• Remote credentialing experience preferred• Modio Software experience preferredIn-Office Requirement:Must attend in-person new hire orientation and report to the office at least quarterly thereafter for required meetings, trainings, and organizational activities.