Provider Credentialing Consultant

RiseMe; Murray (UT); On-site; USD 52,000 - 64,000; Full time

Job summary

University of Utah Health seeks a credentialing professional to manage monthly credentialing and three-year re-credentialing for medical and allied health staff, ensuring compliance and accurate provider data within the credentialing system.

You will maintain documentation, support audits, and liaise with multiple departments to uphold regulatory standards and data integrity. Strong communication and MS Office skills are essential.

Qualifications

• Bachelor's Degree in a Healthcare or Business Management or equivalency.
• Two years of related experience.
• Certified Provider Credentialing Specialist designation preferred.
• Knowledge of NCQA standards and related regulations.

Responsibilities

• Facilitates monthly credentialing and three year re-credentialing process for medical and allied health professional staff to ensure compliance with bylaws and regulatory requirements.
• Implements process improvements to increase efficiency while ensuring compliance with bylaws and regulatory requirements.
• Participates in annual audits of the credentialing program.
• Maintains all credentialing documentation and provider updates to ensure reliable, efficient retrieval of information by staff.
• Analyzes data between provider database and Epic and reporting 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.
• Exhibits excellent customer relations with office visitors, department coordinators, committee members, coworkers and outside contacts.

Skills

Credentialing knowledge

Communication skills

Confidentiality

Detail oriented

Microsoft Office

Data integrity

Relationship management

Research skills

Education

Bachelor's degree in Healthcare or Business Management

Equivalency accepted

Tools

Microsoft Access

Excel

Word

Job description

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, integrity, quality and trust that are integral to our mission. EO/AA

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 Health is an integrated academic healthcare system with five hospitals including a level 1 trauma center, eleven community health centers, over 1,600 providers, and a health plan serving over 200,000 members. University of Utah Health 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. University of Utah Hospitals and Clinics represents our clinical operations for the larger health system.

Responsibilities

Essential Functions

• 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.
• Participates in annual audits of the credentialing program.
• Maintains all credentialing documentation and provider updates to ensure reliable, efficient retrieval of information by staff.
• Analyzes data between provider database and Epic and reporting 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.
• Exhibits excellent customer relations with office visitors, department coordinators, committee members, coworkers and outside contacts through events such as provider education fairs and seminars.

Knowledge / Skills / Abilities

• Knowledge of appropriate credentialing requirements as well as of 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.

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

• Familiarity with NCQA standards and how to apply them.

Qualifications

Required

• Bachelor's Degree in a Healthcare or Business Management or equivalency.
• Two years of related experience.

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

Listening, Manual Dexterity, Sitting, Speaking, Standing