Credentialing and Enrollment Specialist

2 weeks ago


Memphis, Tennessee, United States University Clinical Health Full time

Job Type:
Part-time

About Us:
University Clinical Health (UCH) is a distinguished, independent, physician-led faculty practice plan affiliated with the University of Tennessee Health Science Center. We are committed to delivering exceptional clinical services through a robust network of over 175 healthcare providers across 19 specialties, dedicated to addressing the healthcare needs of the Mid-South community. As a not-for-profit organization, we prioritize serving our community while ensuring the highest standards of medical excellence for our patients.

Position Overview:
The Credentialing and Enrollment Specialist plays a vital role in facilitating the credentialing and enrollment processes for UCH providers. This position is essential for ensuring timely, precise, and compliant management of data related to credentialing, re-credentialing, and enrollment with various insurance carriers.

Key Responsibilities:

  • Credentialing:
    - Conducts online primary source verification for various professional licenses, DEA certifications, and board certifications as required.
    - Updates credentialing information in the Cactus system to maintain compliance.
    - Generates monthly reports on expirable credentials and performs necessary verifications.
    - Safeguards sensitive credentialing data with utmost confidentiality.
  • Enrollment:
    - Supports the provider enrollment process by assisting team members as needed.
    - Accurately inputs provider enrollment data upon receipt of credentialing information.
    - Manages payer assignments and effective dates within the Cactus software.
    - Maintains internal records of provider enrollment and addresses verification requests from payers.
    - Performs additional duties as assigned.

Qualifications:

  • Core Competencies:
    - Strong organizational and analytical skills
    - Familiarity with payer enrollment standards
    - Ability to foster effective working relationships
    - Excellent customer service skills
    - Proficient in interpersonal, written, and verbal communication
    - Detail-oriented with the ability to thrive in a fast-paced environment
  • Education & Experience:
    - 3-5 years of experience in credentialing and enrollment is required
    - An Associate's degree in healthcare or business is preferred
    - Proficiency in credentialing software is required; experience with Cactus software is preferred
    - Intermediate to advanced skills in Word, Excel, and Adobe imaging software

Physical Requirements:
- Ability to lift up to 15 pounds occasionally
- Prolonged periods of sitting and working on a computer for data management tasks



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