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.

If employed by the University of California, you will be required to comply with our Policy on Vaccination Programs, which may be amended or revised from time to time. Federal, state, or local public health directives may impose additional requirements.

If applicable, life-support certifications (BLS, NRP, ACLS, etc.) must include hands-on practice and in-person skills assessment; online-only certification is not acceptable.

UC San Diego Health is the only academic health system in the San Diego region, providing leading-edge care in patient care, biomedical research, education, and community service. Our facilities include two university hospitals, a National Cancer Institute-designated Comprehensive Cancer Center, Shiley Eye Institute, Sulpizio Cardiovascular Center, the only Burn Center in the county, and and dozens of outpatient clinics. We invite you to join our team!

Applications/Resumes are accepted for current job openings only. For full consideration on any job, applications must be received prior to the initial closing date. If a job has an extended deadline, applications/resumes will be considered during the extension period; however, a job may be filled before the extended date is reached.

To foster the best possible working and learning environment, UC San Diego strives to cultivate a rich and diverse environment, inclusive and supportive of all students, faculty, staff and visitors. For more information, please visit UC San Diego Principles of Community.

The University of California is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, age, protected veteran status, or other protected status under state or federal law.

For the University of California's Anti-Discrimination Policy, please visit: https://policy.ucop.edu/doc/1001004/Anti-Discrimination

UC San Diego is a smoke and tobacco free environment. Please visit smokefree.ucsd.edu for more information.

UC San Diego Health maintains a marijuana and drug free environment. Employees may be subject to drug screening.

Misconduct Disclosure Requirement: As a condition of employment, the final candidate who accepts an offer of employment will be required to disclose if they have been subject to any final administrative or judicial decisions within the last seven years determining that they committed any misconduct; or have filed an appeal of a finding of substantiated misconduct with a previous employer.

a. "Misconduct" means any violation of the policies governing employee conduct at the applicant's previous place of employment, including, but not limited to, violations of policies prohibiting sexual harassment, sexual assault, or other forms of harassment, or discrimination, as defined by the employer. For reference, below are UC's policies addressing some forms of misconduct:

• UC Sexual Violence and Sexual Harassment Policy
• UC Anti-Discrimination Policy
• Abusive Conduct in the Workplace