Provider Enrollment and Credentialing Specialist

1 week ago

Memphis, Tennessee, United States University Clinical Health Full time
Job Overview

About Us:

University Clinical Health (UCH) stands as the sole independent and physician-led faculty practice plan affiliated with the University of Tennessee Health Science Center. We are dedicated to delivering exceptional clinical services through a network of over 175 providers across 19 specialties, addressing the healthcare requirements of the Mid-South community. As a not-for-profit organization, UCH is committed to serving the community while ensuring medical excellence for our patients.

Role Summary:

The Provider Enrollment and Credentialing Specialist plays a crucial role in facilitating the credentialing and enrollment processes for UCH providers. This position entails precise, timely, and compliant management of data, along with ongoing monitoring tasks related to credentialing, re-credentialing, and enrollment with insurance carriers.

Key Responsibilities:

  • Credentialing:

- Conducts online primary source verification of professional licenses, DEA certifications, and board certifications as required.

- Updates credentialing information in the Cactus system to ensure compliance.

- Generates monthly reports of expiring credentials and performs necessary verification updates.

- Safeguards sensitive credentialing data with utmost confidentiality.

  • Enrollment:

- Assists colleagues in the provider enrollment process as needed.

- Accurately inputs provider enrollment data upon receipt of credentialing updates.

- Maintains records of payer assignments and effective dates within the Cactus software.

- Responds to verification inquiries from payers and maintains internal provider enrollment records.

- Undertakes additional responsibilities as assigned.

Qualifications:

  • 3-5 years of experience in credentialing and enrollment is essential.
  • An Associate's degree in healthcare or business is preferred.
  • Experience with credentialing software is required; familiarity with Cactus software is a plus.
  • Proficient in Microsoft Word, Excel, and Adobe imaging software.

Core Competencies:

  • Strong organizational, analytical, and problem-solving abilities.
  • Understanding of payer enrollment standards.
  • Ability to foster and maintain effective working relationships.
  • Excellent customer service skills.
  • Outstanding interpersonal, written, and verbal communication skills.
  • Detail-oriented approach in a dynamic environment.

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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