Credentialing & Enrollment Specialist

Description

Who We Are:

As the only independent and physician-led faculty practice plan of the University of Tennessee Health Science Center, University Clinical Health (UCH) offers best-in-class clinical care through a network of 175+ providers across 19 specialties to meet the healthcare needs of the Mid-South community. UCH is a not-for-profit, non-tax-supported group practice and is here to serve the community while providing medical excellence to our patients. 

Position Summary:

The Provider Credentialing and Enrollment Specialist is responsible for supporting the credentialing and payer enrollment activities of the University Clinical Health providers through timely, accurate, and compliant data management and ongoing monitoring tasks related to credentialing, re-credentialing, enrollment with insurance carriers. 

Key Results Areas (KRAs):

• Credentialing:

o Performs online primary source verification of NPDB, TN and out-of-state professional licenses, DEA certification; AMA or AOA Profile, National Student Clearing House, board certification, or other required online verifications as needed. 

o Updates credentialing data in Cactus as required for regular compliance.

o Runs monthly expirable list and performs associated primary source verification updates, as applicable (licenses, board certificates, DEA). 

o Manages sensitive credentialing information with a high degree of confidentiality and security.

• Enrollment: 

o Assists team members in the provider enrollment process as requested. 

o Accurately enters provider enrollment data upon receipt of UCH credentialing or updates data in Cactus upon receipt of re-credentialing application. 

o Enters payer assignments and effective dates in the Cactus software.

o Maintains internal provider enrollment and responds to verification requests from payers. 

o Performs other duties as assigned. 

Requirements

Core Competencies 

• Strong organizational, critical thinking and problem- solving skills 
• Working knowledge of payer enrollment standards 
• Ability to develop and maintain effective working relationships
• Strong customer service orientation 
• Excellent interpersonal, written, and verbal communication skills
• Ability to be detailed- oriented in a fast-paced environment 

Education & Experience:

• 3-5 years credentialing and enrollment experience or other relevant Medical/Revenue Cycle experience required 
• Associate's degree in health care or business preferred 
• Credentialing software required; Cactus software preferred 
• Intermediate to expert working knowledge of Word, Excel, and Adobe imaging software

Physical Requirements

• Must be able to lift up to 15 pounds at times
• Prolonged periods sitting and working on a computer to complete necessary data management