Provider Health Plan Enrollment Analyst - UCSF Medical Center
Posted on October 19th, 2015
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Provider Health Plan Enrollment Analyst - Medical Staff Office
Laurel Heights Location; San Francisco, CA
Job ID # 9951
Job Summary
Within a high volume, goal driven environment (estimated target: 25 applications per week), this position will process and ensure that all billing providers at UCSF and affiliates are accurately and compliantly credentialed and enrolled into all commercially contracted health plans, Medicare, Medi-Cal and Tricare.
Billing providers include, but are not limited to UCSF Medical Staff, Advanced Health Professionals and CVO contracted facilities (LPPH&C, School of Dentistry and others, as applicable). Initiate and cultivate partnerships with department management, medical staff/hospital, and health plan leadership to ensure optimal efficiency for appropriate health plan enrollments. First responder to data integrity/system interface issues as well as performs auditing functions pursuant to UCSF policies and procedures, The Joint Commission and NCQA standards, commercial contracted agreements, as well as State and Federal laws and regulations including the Affordable Care Act. Conducts research and analysis related to health plan enrollment to help support new policies and procedures and to help implement new workflow strategy to sustain best practice.
This position works directly with the Associate Director and Program Manager to develop and establish sustainable work flow processes related to Health Plan Enrollment. This position works directly with UCSF billing agents and contracted health plans to resolve billing issues on a daily basis.
Required Qualifications
-Bachelor’s degree or equivalent combination of education and experience; graduate degree can be substituted for experience
-Minimum of 4 -5 years of work experience in healthcare environment with specific emphasis in provider enrollment, managed care, health plans affairs at an academic medical center and/or medical staff operations
-CPC or CPCS/CPMSM certification (or obtained within 18 months of hire)
-Knowledge of the regulations (TJC, CMS, CDHS, NCQA, HCFA etc.) regarding the operations of a Provider Enrollment operation, and/or Medical Staff Services Office, and/or a Credentialing Verification Office. Able to review and understand local, state, and federal regulations
-Previous experience working in a work environment that requires a high-level of confidentiality and sensitivity, and an understanding of the regulatory requirements for maintaining this confidentiality
-Ability to maintain confidentiality and use discretion when handling sensitive medical staff issues
-Ability to organize, prioritize, and monitor assignments and workload
-Possess ability to set priorities and manage multiple demands effectively.
-Ability to work with credentialing staff with special performance improvement projects
-Excellent, proven writing skills and outstanding organization/planning skills to anticipate workload deadlines
-Proficiency with MS Office, Epic EMR system, HLS/ECHO, or other credentialing software
-Familiar with Provider Enrollment Chain and Ownership System (PECOS), Identity & Access Management Systems (I&A), and National Plan & Provider Enumeration System (NPPES)
-Excellent communication, conflict-management skills, and customer-service skills
-Ability to interact with all levels of the Medical Staff, including Medical Staff leaders, Department Chairs, Division/Service Chiefs, and medical staff providers
-Ability to function well within a team and independently
-This position requires the flexibility to orient and work in all UCSF Medical Center locations
Preferred Qualifications
-Master’s degree in Public Health or Public Administration
-Previous experience with Provider Enrollment, Medical Staff credentialing or medical staff/governance committees, and/or working with highly confidential/sensitive materials
Licensure/Certification
-CPC or CPCS/CPMSM certification (or obtained within 18 months of hire)
We offer a comprehensive benefits package effective on the first day of employment and a location in the heart of San Francisco.
Apply online at
http://jobs.ucsfmedicalcenter.org/
for official consideration and search using the
Job Opening ID 9951.