Sr. Credentialing Specialist
Job location: Coral Gables, FL
Employment Type: Full-time
Posted data: 2019-09-11
If you are a current Staff, Faculty or Temporary employee at the University of Miami, please click here to log in to Workday to use the internal application process. To learn how to apply for a faculty or staff position using the Career worklet, please review this tip sheet.Where Excellence Meets PurposeThe University of Miami is among the top research universities and academic medical centers in the nation, and one of the largest private employers in South Florida.With more than 16,000 faculty and staff, the University strives for excellence, and is driven by a powerful purpose to transform and impact the lives of its students, patients, members of the community, and people across the globe.The University is committed to fostering a culture of belonging, where everyone feels valued and has the opportunity to add value. Through values of Diversity, Integrity, Responsibility, Excellence, Compassion, Creativity, and Teamwork (DIRECCT) the U community works together to create an environment driven by purpose, excellence, community, and service.The University has been named on Forbes's Best Employers list for two consecutive years, and is the only university in Florida to receive this honor.
The department of Business Development & Managed Care is actively seeking a Senior Credentialing Specialist. The Senior Credentialing Specialist ensures compliance with all regulatory, accrediting and membership-based organizations via development and implementation of a comprehensive credentialing process, for physicians and other healthcare professionals who practice within the University delivery system.
CORE JOB FUNCTIONS
- Maintains UHealth provider credentialing database(s) and ensures all relevant data is accurate.
- Collaborates with UHealth Credentialing department and UHealth medical practice departments in order to expedite UHealth’s practitioner credentialing process.
- Communicates with contracted Payors regularly in order to deliver updated UHealth provider credentialing updates received from UHealth Credentialing Department
- Sets up and initiates optimal process with contracted Payors to ensure UHealth practitioners are loaded and configured with Payor systems and reflect accurate information within Payor provider directories and other systems of provider display.
- Initiates and maintains an ongoing process with contracted payors that validates the UHealth provider information is accurate.
- Conducts regular auditing to ensure all UHealth practitioners’ records are current and accurate within both UHealth Credentialing and contracted Payor systems.
- Provides continuous feedback to UHealth’s Credentialing Committee related to the functions of process improvement and timeliness of provider loading in Payors’ systems.
- Negotiates optimal rates of reimbursement and contractual terms and conditions with non-contracted Payers on behalf of UHealth when its hospital or physicians are not contracted or in Payer’s Provider network.
- Works with various UHealth departments to ensure Single Case Negotiations (SCN) are properly executed and loaded within UHealth systems.
- Adheres to departmental policies, procedures, guidelines, regulations, and applicable laws.
- Adheres to University and unit-level policies and procedures and safeguards University assets.
- Responsible for ensuring all UHealth physicians and other health practitioners (Providers) are loaded with up-to-date information on the various Payors’ systems and provider directories.
- Obtains Payers’ downloaded roster of UHealth Providers and audits for accuracy.
- Collaborates with Payors to ensure their various internal systems’ and provider directories are current and accurate with UHealth’s Provider information.
- Stays current with Payors’ and the Florida Agency requirements for Provider credentialing
This list of duties and responsibilities is not intended to be all-inclusive and may be expanded to include other duties or responsibilities as necessary.
- Bachelor’s degree in relevant field required
- Minimum 1 year of relevant experience required
Knowledge, Skills and Attitudes:
- Skill in data entry with minimal errors.
- Ability to maintain effective interpersonal relationships.
- Skill in collecting, organizing and analyzing data.
- Skill in completing assignments accurately and with attention to detail.
- Ability to analyze, organize and prioritize work under pressure while meeting deadlines.
- Commitment to the University’s core values.
- Ability to work independently and/or in a collaborative environment.
Any appropriate combination of relevant education, experience and/or certifications may be considered.
UHealth-University of Miami Health System, South Florida's only university-based health system, provides leading-edge patient care powered by the ground breaking research and medical education at the Miller School of Medicine. As an academic medical center, we are proud to serve South Florida, Latin America and the Caribbean. Our physicians represent more than 100 specialties and sub-specialties, and have more than one million patient encounters each year. Our tradition of excellence has earned worldwide recognition for outstanding teaching, research and patient care. We're the challenge you've been looking for.
Patient safety is a top priority. As a result, during the Influenza ("the flu") season (September through April), the University of Miami School of Medicine requires all employees who provide ongoing services to patients, work in a location (all Hospitals and clinics) where patient care is provided, or work in patient care or clinical care areas, to have an annual influenza vaccination. Failure to meet this requirement will result in rescinding or termination of employment.
The University of Miami is an Equal Opportunity Employer - Females/Minorities/Protected Veterans/Individuals with Disabilities are encouraged to apply. Applicants and employees are protected from discrimination based on certain categories protected by Federal law. Click here for additional information.Job Status:Full timeEmployee Type:StaffPay Grade:c104