Credentialing Specialist at UC HEALTH LLC in Cincinnati, Ohio

Job Description:

At UC Health, we're proud to have the best and brightest teams and clinicians collaborating toward our common purpose: to advance healing and reduce suffering.

As the region's adult academic health system, we strive for innovation and provide world-class care for not only our community, but patients from all over the world. Join our team and you'll be able to develop your skills, grow your career, build relationships with your peers and patients, and help us be a source of hope for our friends and neighbors.

UC Health is committed to providing an inclusive, equitable and diverse place of employment.

This is a multi-faceted position encompassing elements of administrative tasks, customer service, and credentialing verifications. Prepares, documents, and completes credentialing data processes including applications and verifications for Medical and Allied Health staff. Performs administrative tasks, such as compiling data from providers, preparing applications, maintaining clean and organized files, and maintaining current documents and enrollments for providers.Minimum Required: High School Graduate diploma or GED required. | CPCS (Certified Provider Credentialing Specialist) is preferred. | 1-4 Years in a business office. Health care and credentialing experience in hospital, physician office, or managed care preferred.Prepares, documents, and completes credentialing data processes.

Performs regularly recurring administrative tasks for maintaining Payor Enrollment data files.

Training and Self Development.

Customer Service.

Maintains Payor Enrollment data files to support effective entry, filing, storage, and retrieval of data and documents.

Assists department with performance improvement activities, clean up projects, and other duties as assigned.

Communicates with providers to gather information needed to enroll them with payors.

Update CAQH and Cactus database with new provider information.

Collates information and prepares credentialing files for review

Populate paper applications, Excel documents and online websites/portals to enroll providers.

Follows up on applications submitted.

Respond to requests for additional information needed for enrollments.

Submit revalidation/recertification applications every three to five years to maintain provider enrollments.

Respond to notices from payors needing information to maintain enrollments and payor directories.

Reattest CAQH every 120 days for all providers.

Submit license, DEAs and malpractice to payors to maintain enrollments.

Update CAQH and Cactus with demographic and name changes and submit updates to all payors.

Receives, opens, sorts and distributes mail/emails.

Participate in staff training that aligns with recognized improvement opportunities.

Work with supervisors and coworkers to learn all parts of the Enrollment Team.

Makes customer service a high priority. Listens to, identifies, and responds quickly and appropriately to customer needs, both internal and external customers

Respond in timely manner

Execute required actions

Identify potential problems

Handles confidential materials

Maintain storage of files for orderly retrieval.Prepares, documents, and completes credentialing data processes.

Performs regularly recurring administrative tasks for maintaining Payor Enrollment data files.

Training and Self Development.

Customer Service.

Maintains Payor Enrollment data files to support effective entry, filing, storage, and retrieval of data and documents.

Assists department with performance improvement activities, clean up projects, and other duties as assigned.

Communicates with providers to gather information needed to enroll them with payors.

Update CAQH and Cactus database with new provider information.

Collates information and prepares credentialing files for review

Populate paper applications, Excel documents and online websites/portals to enroll providers.

Follows up on applications submitted.

Respond to requests for additional information needed for enrollments.

Submit revalidation/recertification applications every three to five years to maintain provider enrollments.

Respond to notices from payors needing information to maintain enrollments and payor directories.

Reattest CAQH every 120 days for all providers.

Submit license, DEAs and malpractice to payors to maintain enrollments.

Update CAQH and Cactus with demographic and name changes and submit updates to all payors.

Receives, opens, sorts and distributes mail/emails.

Participate in staff training that aligns with recognized improvement opportunities.

Work with supervisors and coworkers to learn all parts of the Enrollment Team.

Makes customer service a high priority. Listens to, identifies, and responds quickly and appropriately to customer needs, both internal and external customers

Respond in timely manner

Execute required actions

Identify potential problems

Handles confidential materials

Maintain storage of files for orderly retrieval.