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.
UC San Diego is an academic powerhouse and economic engine, recognized as one of the top 8 public universities by U.S. News and World Report. Innovation is central to who we are and what we do. Here, students learn that knowledge isn't just acquired in the classroom - life is their laboratory. UC San Diego's rich academic portfolio includes six undergraduate colleges, five academic divisions and five graduate and professional schools. The university's award-winning scholars are experts at the forefront of their fields with an impressive track record for achieving scientific, medical and technological breakthroughs.