Description

 This position provides an extensive benefit program which includes:

• Hybrid Schedule/Remote Work Opportunities after a 90 day onsite training period
• Casual Work Environment
• Insurance Package: Medical, Dental, Vision, Life, Disability
• Paid Time Off (PTO), Sick, Mental Health, and Volunteer Pay
• Onsite Fitness Center
• Employee Assistance Program (EAP)
• 401k Matching and immediate vesting

Summary/Objective

Responsible for the credentialing and enrollment of UPA providers with commercial and government

payers. Works with assigned department staff to ensuring required documentation is obtained and

complete for a smooth enrollment process.

Essential Functions

1. Prepare initial and recredentialing plan applications for non-delegated payers for UPA providers, as well as other providers who are Essential Services clients.
2. Follow up and track provider applications submitted to payers. Contact payers regarding status of applications and document/update the credentialing/enrollment database with status.
3. Process changes and terminations from departments and practices timely
4. Works closely with Managed Care to ensure the credentialing application process is efficient and meets established turnaround times.
5. Update CAQH database. Maintain the integrity of provider and practice information.
6. Review credentialing and recredentialing files for accuracy and completeness. Performs primary source verification of practitioner credentials based on the policies and procedures of UPA and the federal and state regulatory agencies and accrediting bodies.

Requirements

Competencies

1. Good oral and written communication skills.
2. Ability to meet scheduled deadlines with minimal supervision.
3. Strong organization skills and accurate work results.
4. Ability to maintain a professional demeanor and confidentiality.
5. Knowledge of CMS, NCQA, State and Federal regulations related to health plan credentialing activities.
6. Detail oriented.
7. Accomplish responsibilities accurately and expeditiously.
8. Ability to multi-task and deal with complexity on a frequent basis.
9. Flexible, team player.
10. Self-starter and self-motivated, functions independently with minimal direction.