111879 - Provider Enrollment & Credentialing Analyst-Remote
As a federally-funded institution, UC San Diego Health maintains a marijuana and drug free campus. New employees are subject to drug screening.
#111879 Provider Enrollment & Credentialing Analyst-RemoteFiling Deadline: Wed 10/20/2021
For the safety and well-being of the entire university community, the University of California requires, with few exceptions, that all students, faculty and staff be vaccinated against the COVID-19 virus before they will be allowed on campus or in a facility or office. For more information visit: https://ucnet.universityofcalifornia.edu/news/2021/10/flu-vaccination-requirement-for-uc-students,-faculty-and-staff-issued-for-2021-2022.html
UCSD Layoff from Career Appointment: Apply by 10/08/21 for consideration with preference for rehire. All layoff applicants should contact their Employment Advisor.
Special Selection Applicants: Apply by 10/20/21. Eligible Special Selection clients should contact their Disability Counselor for assistance.
Candidates hired into this position will be able to work remotely.
The Provider Enrollment and Credentialing Analyst is responsible for the operational Provider enrollment process in all federal programs and for monitoring the effectiveness and accuracy of submitted provider rosters and correspondence to the various health plans delegated for credentialing. Maintains provider database, ensuring status, active or terminated is accurately noted in the master records to drive downstream provider enrollment applications and payer rosters necessary to for the on-boarding and off-boarding of providers in a timely manner. Ensures notice of terminated providers are sent to medical staff and contracting departments on a monthly basis. Coordinates Provider Education requirements with the departments related to the on-boarding process to ensure UC San Diego Health mandated education requirements are completed prior to seeing patients.
Oversees the government provider enrollment process with all federal programs including maintenance of the Medicare enrollment process through PECOS and Medicaid through PAVE. Resolves issues causing delays in the timely on-boarding and enrollment of new providers and the ongoing re-validation of existing providers. Maintains knowledge of accreditation and regulatory standards required for compliant credentialing and maintenance of provider credentialing files.
Minimizes risks to UC San Diego through timely completion of assigned credentialing duties and preparing of requisite notices where reporting of findings are required in accordance with specific accrediting body standards. Processes credentialing applications for initial and re-credentialing in accordance with NCQA standards and payer credentialing requirements to meet delegation agreements. Ensures assigned credentialing and quality files are accurate and up-to-date for the providers whom the system bills professional fees on behalf of including, but not limited to: Physicians, Allied Health Providers, Ancillary, and Behavioral Health Providers. Performs Primary Source Verification on assigned credentialing files per NCQA, CMS, DHCS, and DMHC Standards.
Six (6) years of related experience, education/training in a large multi-specialty group or hospital setting, with knowledge in the credentialing process and revenue cycle, OR a Bachelor’s degree in related area plus two (2) years of related experience/training in a large multi-specialty group or hospital setting, with knowledge in the credentialing process and revenue cycle.
Experience and proven success in federal and state compliance guidelines for Provider Enrollment.
Knowledge of UC accounting and administrative policy and procedures.
Maintain organization while be extremely focused on details.
Capable of meeting time-sensitive deadlines for multiple tasks.
Professional written and verbal communication.
- Certified Provider Credentialing Specialist (CPCS) or Certified Professional Coder (CPC).
- Knowledge of out of state Medicaid enrollment and credentialing.
- Experience with EPIC.
- Experience with Microsoft Office.
- Must be able to work various hours and locations based on business needs.
- Employment is subject to a criminal background check and pre-employment physical.
Job offer is contingent on successful engagement in the UC COVID-19 Vaccination program (fully vaccinated with documented proof or approved exception/deferral).
UC San Diego Health is the only academic health system in the San Diego region, providing leading-edge care in patient care, biomedical research, education, and community service. Our facilities include two university hospitals, a National Cancer Institute-designated Comprehensive Cancer Center, Shiley Eye Institute, Sulpizio Cardiovascular Center, and several outpatient clinics. UC San Diego Medical Center in Hillcrest is a designated Level I Trauma Center and has the only Burn Center in the county. We invite you to join our dynamic team!
Applications/Resumes are accepted for current job openings only. For full consideration on any job, applications must be received prior to the initial closing date. If a job has an extended deadline, applications/resumes will be considered during the extension period; however, a job may be filled before the extended date is reached.
UC San Diego Health is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, age, protected veteran status, gender identity or sexual orientation. For the complete University of California nondiscrimination and affirmative action policy see: http://www-hr.ucsd.edu/saa/nondiscr.html
UC San Diego is a smoke and tobacco free environment. Please visit smokefree.ucsd.edu for more information.