Credentialing and Provider Enrollment Specialist

1 week ago


Charlottesville, Virginia, United States University of Virginia Full time
Job Summary

This position plays a critical role in ensuring the University of Virginia's compliance with delegated credentialing and enrollment processes for healthcare providers. The successful candidate will be responsible for managing the enrollment process, including tracking applications, resolving issues, and maintaining accurate records.

Key Responsibilities
  • Manage the enrollment process for healthcare providers, including tracking applications and resolving issues
  • Collaborate with the Insurance Processing Unit to resolve provider-related claim denials
  • Work with payors to ensure accurate and timely enrollment information
  • Coordinate with UPG Legal, UVA HR, and UVA Clinical Staff Office to facilitate timely enrollment of leased professional providers
  • Authorize updates to the provider professional billing record in EPIC
  • Collaborate with UPG IPU to resolve provider-related claim denials and act as liaison between payor and UPG
  • Assist with payor transparency by communicating discrepancies between payor and UPG/UVACHMG enrollment information
  • Responsible for updating and entry of all physician and allied health professional credentialing information into the Symplr provider database
  • Assist with projects related to new practice locations for UPG and UVACHMG, including relocation and changes
  • Maintain confidentiality of credentialing and enrollment information
  • Provide backup coverage to the others on the enrollment team
Requirements
  • High school graduate or equivalent required; Bachelor's Degree preferred
  • 5 years prior experience in a healthcare environment
  • Experience working accurately under time pressures
  • Experience anticipating end users' problems
  • Intermediate knowledge of and experience utilizing a personal computer
  • Intermediate word processing and spreadsheet skills
  • Basic knowledge of database software or willingness to attain such within 6 months of hire


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