Provider Enrollment & Credentialing Analyst - 138596

UC San Diego Health's Revenue Cycle department supports the organization's mission to deliver outstanding patient care and to create a healthier world - one life at a time. We are a diverse, patient-focused, high-performing team with a commitment to quality, collaboration, and continuous improvement that enables us to deliver the maximum standard of care to our patients. We offer challenging career opportunities in a fast-paced and innovative environment and we embrace individuals who demonstrate a deep passion for problem-solving and customer service.

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. 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, OR a Bachelor's degree in related area plus two (2) years of related experience/training

• Knowledge of federal and state compliance guidelines in a medical setting. Knowledge of UC accounting and administrative policy and procedures.

• Skills to evaluate issues and identify a potential solution.

• Proven organizational skills with the ability to effectively manage time and prioritize tasks. Attention to detail.

• Communication and interpersonal skills to interact with faculty and staff at all levels in a fast-paced environment under consistent pressure with the ability to work well with others and accept direction.

• Ability to perform all commonly applicable functions in Microsoft Office Suite (Word, Excel, PowerPoint) and medical credentialing database application.

• Data analysis, research and reporting skills.

• Certified Provider Credentialing Specialist (CPCS).

• MSOW

• Crystal Reports

• 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.