Credentialing and Enrollment Specialist

    • Job Tracking ID: 512635-590483
    • Job Location: Memphis, TN
    • Job Level: Mid Career (2+ years)
    • Level of Education: BA/BS
    • Job Type: Full-Time/Regular
    • Date Updated: September 08, 2017
    • Years of Experience: 5 - 7 Years
    • Starting Date: October 2, 2017
    • PCN: ACS0187
    • Position: Credentialing and Enrollment Specialist
    • Date: 9/8/2017
    • FLSA Status: Exempt,Non Exempt
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Job Description:

The Credentialing and Enrollment Specialist is responsible for assisting the Senior Manager of Credentialing and Enrollment in the overall efficiency and efficacy of the credentialing and enrollment program, through application of NCQA and TJC accreditation standards, applicable regulatory standards, payor requirements and the policies of University Clinical Health. The Credentialing and Enrollment Specialist serves as a lead expert in all activities related to credentialing, recredentialing, enrollment and hospital privileging, while employing a high degree of organizational and time management skills to accurately and timely ensure completion of the same.

Experience and Skills:

KEY RESULT AREAS (KRAs)

¨ Coordinate all credentialing, enrollment and hospital privileging activities and track progress/status in Cactus.

¨ Maintain and apply working knowledge of NCQA and TJC accreditation and regulatory standards related to all aspects of credentialing.

¨ Function as an expert in the ongoing management of practitioner credentialing data in Cactus.

¨ Oversee, verify, compile, manage and maintain confidential provider information related to initial credentialing, recredentialing, payor enrollment and hospital privileging.

¨ Manage sensitive credentialing information with a high degree of confidentiality and security.

¨ Identify, assess and report on potential red flags discovered in the credentialing process; conduct appropriate follow-up with primary sources and provider-applicants, as necessary.

¨ Manage timelines for initial credentialing, recredentialing, payor enrollment and hospital privileging in Cactus (UCH/Hospital/Payor Assignments) within prescribed time lines.

¨ Prepare credentialing, recredentialing, enrollment and hospital privilege status reports for Leadership, as requested.

¨ Work collaboratively with internal colleagues and leaders across the organization to resolve issues related to credentialing, recredentialing, enrollment and hospital privileging.

¨ Other duties as assigned.

KNOWLEDGE, SKILLS & ABILITIES, EDUCATION and/or EXPERIENCE

¨ Minimum of 5 years in healthcare environment with direct-related provider credentialing and enrollment experience, or an equivalent combination of training and relevant work experience required. Bachelor’s degree in health care administration, business, or legal discipline preferred.

¨ Certification by the National Association of Medical Staff Services (NAMSS) as a Certified Provider Credentialing Specialist (CPCS) or Certified Professional Medical Services Management (CPMSM) within 2 years of hire.

¨ Ability to master and employ a variety of complex procedures, methods, and processes, involving the use of skills acquired through specialized training and experience.

¨ Knowledge of NCQA and JCAHO standards required.

¨ Knowledge of Medicare/Medicaid/TennCare regulations, PPO, and HMO arrangements, third party payer protocols, and medical terminology.

¨ Ability to develop and maintain effective working relationships.

¨ Strong organizational, critical thinking and problem-solving skills.

¨ Intermediate to expert working knowledge of Word, Excel and Adobe imaging software.

¨ Cactus, or similar credentialing software knowledge strongly preferred.

¨ Demonstrated high levels of initiative, innovation, and collaboration.

¨ Desire for process improvement.

¨ Strong customer service orientation

¨ Strong time management and priorities management skills

¨ Excellent interpersonal, written and verbal communication skills

¨ Detail-oriented with the ability to multi-task


Appointments will be based on merit as it relates to position requirements without regard to race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability, or veteran status. Successful candidates must submit documentation verifying employment eligibility and identity and successfully pass a drug test to be employed by University Clinical Health. External candidates apply online at http://universityclinicalhealth.com/careers. University Clinical Health is committed to ensuring equal employment opportunity, including providing reasonable accommodations to individuals with a disability. Applicants with a physical or mental disability who require a reasonable accommodation for any part of the application or hiring process may contact the Human Resource Department at 901-866-8100 or fax 901-302-2008.