OBJECTIVE/OVERVIEW: Under limited supervision, the provider enrollment specialist applies provider enrollment/credentialing knowledge to efficiently coordinate provider enrollment/credentialing, facilitation of state licensing, DEA, liability insurance applications/renewals. Independently coordinates activities to ensure completion of the provider enrollment functions for CUHCC. The provider enrollment specialist also ensures 3Ps tracked and up to date. This role supports and adheres to CUHCC’s policies and procedures, particularly in areas of compliance, including the Code of Conduct and Business Standards. This position will also follow all UMN and CUHCC policies, procedures, protocols, and manuals as it applies to the duties and assures compliance and other regulatory requirements.
REPORTING RELATIONSHIPS: This position reports directly to the Compliance Director.
INTERNAL & EXTERNAL RELATIONSHIPS: Internal: Work with all staff to maintain credentialing, licensure and privileging as required; work with leaders and managers to track and update 3Ps. External: Insurance payers, state board and regulatory entities and other external partners and stakeholders as needed.
ESSENTIAL FUNCTIONS 1. Accountable administrator for provider enrollment (35%) a. Timely completion and submission of initial, add credentialing, and re-credentialing and privileging/provider enrollment applications for all billable providers; facilitation of state licensing, DEA, NPI. b. Submit and review liability insurance applications/renewals. c. Serves as a liaison between the CUHCC providers, hospital medical staff offices if applicable, billing team, and contracted third party payers in coordinating the privileging/provider enrollment process. d. Responsible for timely and accurate maintenance of information in the credentialing databases (e.g. Symed (OneApp) and MCC) and resolution of system edits. e. Update and track licenses, certificates, government picture identification, immunizations, car insurance relevant to staff’s role. f. Display licenses as required in departments & track where licenses are displayed. g. Complete quarterly audits to ensure accuracy (OneApp) h. Conduct Primary Source Verifications (PSV) for new hires. i. Ensure background checks are cleared and tracked for staff as needed. j. Initiate Collaborative Agreements (Pharmacy/Dental, APRNs). k. Work with CEO i. onboarding/separation for Board of Directors. ii. Medicare Enrollment for Board of Directors and Providers iii. Clinic credentialing and re-credentialing
2. Administrative compliance, onboarding and exiting functions for Staff and Learners (30%) a. Initiate onboarding and exiting b. Ensure all credentials and onboarding information are gathered and entered into OneApp and Convercent as applicable. c. Ordering new staff/learners name tags as needed. d. Initiate, Track and update CUHCC training in compliance system (Convercent/Qualtrics). e. Quarterly Audits to ensure accuracy onboarding and training. f. Update and track Staff Directory.
3. Accountable administrator of the policies, procedures and protocols (3Ps) (30%) a. Accountable for reviewing, updating and tracking policies, procedures and protocols for CUHCC as needed for admin. b. Be familiar with CUHCC Intranet and Convercent & keeping CUHCC’s the sites up to date for 3Ps. c. Develop a working relationship with Senior Leadership and other staff to accomplish 3P tasks in an appropriate time frame.
4. Other duties as assigned (5%) a. Other administrative functions. b. Supporting ‘Meaningful Use’ by performing administrative functions for health information team.
Hourly Salary Range: $17.31 - $29.10
All required qualifications must be documented on application materials.
REQUIRED QUALIFICATIONS: 1. High school diploma or GED and five years related experience in healthcare. Coursework in a related field may substitute for some years of experience. 2. Extensive PC knowledge and skills with various software applications including electronic medical record systems. 3. Demonstrated project management experience. 4. Knowledge of provider enrollment/credentialing and privileging from a payer or medical environment. 5. Policies, Procedures, and Protocol experience
REQUIRED SKILLS/COMPETENCIES 1. Strong written and verbal communication skills. Demonstrated conflict resolution experience. 2. Critical thinking skills. Must be able to apply knowledge from one process to another to demonstrate an understanding of the job functions. 3. Ability to work with patients, customers and clinical personnel in a professional manner and remain calm and helpful under pressure. 4. Ability to prioritize, problem solve and multi-task and perform in a high demanding environment to meet established goals. 5. Must understand and apply state and federal rules including the Privacy Act and Health Insurance Portability and Accountability Act related to access and disclosure of protected health information to all aspects of the job. 6. Must be able to perform job functions independently with a moderate degree of supervision. 7. Strong communication and interpersonal skills. 8. Ability to work with patients and staff from diverse cultures, languages and backgrounds. 9. Ability to work in a team setting and in close cooperation with others in an office setting. 10. Ability to sit for long periods of time and work in front of a computer screen.
PREFERRED QUALIFICATIONS: • Post-secondary education or equivalent work experience. • Experience using ApplySmart/MCC and OneApp credentialing databases. • Experience using SyMed. • Demonstrated proficiency in a relevant second language.
Internal Number: 331458
About University of Minnesota, Twin Cities
The University of Minnesota, founded in the belief that all people are enriched by understanding, is dedicated to the advancement of learning and the search for truth; to the sharing of this knowledge through education for a diverse community; and to the application of this knowledge to benefit the people of the state, the nation, and the world.