Job Description

Job Description

Responsibilities

This position is remote until further notice, but will require travel to the Malvern, PA office when offices are open. Your office computer will be sent to you. Training will be conducted via Zoom.

Credentialing Specialist

* Ensures that the credentialing requirements for governmental agencies and commercial managed care insurers/networks are met and managed appropriately and timely so that physicians are enrolled in and maintain active credentialing status with such entities. Also responsible for credentialing, as assigned, to other IPM physician group models.
* Submits and follow up on credentialing to all contracted commercial payors and government agencies timely and accurately.
* Supports other IPM locations with credentialing as needed and maintains close working relations with appropriate contacts to keep them well informed. Maintains appropriate tracking of time and promptly reports it on a weekly basis as established by the Credentialing Department.
* Enters and maintains data in the credentialing database, Intellisoft, according to established data entry rules and policies. Performs database queries and reports as needed.
* Ensures that demographic changes to contracted physicians are promptly reported to all contracted managed care companies and governments agencies.
* Maintains managed care contract files (paper and electronic) and department databases for contracts and credentialing
* Supports other physicians recruited by hospital under a guarantee in efforts to perform credentialing functions as needed and agreed upon by physician and Credentialing Manager.
* Keeps all internal departments informed of any contracted payor changes that may impact day to day operations
* Acts as liaison with the Central Business Office (CBO) as point person to ensure

Qualifications

* High School Diploma/GED required. Bachelor's degree preferred, but commensurate work experience in progressively responsible administrative positions will be considered.
* Comprehensive knowledge of the managed care industry, with specific emphasis on physician credentialing and/or physician contracting requirements.
* A broad understanding of the managed care contracting process is required and knowledge of managed care payers processes.
* Responsible for credentialing activities as it relates to initial credentialing, re-credentialing, and credentials modification.
* Ability to communicate effectively both verbally and in writing with internal departments, physicians, physician group management staff and managed care companies in order to achieve the necessary results required in the credentialing process and support of the Credentialing Department.
* compliance and delivery of required information in a timely manner
* Actively engages in supporting department contracting and negotiation efforts as needed
* Assists internal departments with questions and issues. Performs other duties and works on special projects as requested.

EEO Statement

All UHS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. UHS subsidiaries are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state or local laws.

We believe that diversity and inclusion among our teammates is critical to our success.

Notice

At UHS and all our subsidiaries, our Human Resources departments and recruiters are here to help prospective candidates by matching skillset and experience with the best possible career path at UHS and our subsidiaries. We take pride in creating a highly efficient and best in class candidate experience. During the recruitment process, no recruiter or employee will request financial or personal information (Social Security Number, credit card or bank information, etc.) from you via email. The recruiters will not email you from a public webmail client like Hotmail, Gmail, Yahoo Mail, etc. If you are suspicious of a job posting or job-related email mentioning UHS or its subsidiaries, let us know by contacting us at: https://uhs.alertline.com or 1-800-852-3449.