Note: The job is a remote job and is open to candidates in USA. University of Utah Health is an integrated academic healthcare system seeking a Provider Credentialing Consultant for its Health Plans department. The role manages initial and re-credentialing processes, maintains provider credentialing data and documentation, ensures regulatory compliance, analyzes discrepancies between systems, and supports audits and special projects.
Responsibilities
- 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
Skills
- 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
- Bachelor's Degree in a Healthcare or Business Management or equivalency
- Two years of related experience
- 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
- Listening, Manual Dexterity, Sitting, Speaking, Standing
- Certified Provider Credentialing Specialist designation
Benefits
- Remote workplace setup
Company Overview