Credentialing and Payer Enrollment Analyst

Office of Medical Affairs & Governances

Full Time

77034BR

Job Summary

Applies credentialing policy knowledge to follow processes for maintaining department credentialing and licensure. Serves as day-to-day administrative support for the medical services office. Applies knowledge of provider enrollment and regulations to coordinate physician and non-physician health plan enrollment. Serves as liaison between providers and health plans to ensure timely processing.

Uses skills as a seasoned, experienced professional with a full understanding of industry practices and organizational policies and procedures; resolves a wide range of issues in imaginative as well as practical ways. Works on problems of diverse scope where analysis of data requires evaluation of identifiable factors. Demonstrates good judgment in selecting methods and techniques for obtaining solutions. Contacts are both internal and external to the department.

The final salary and offer components are subject to additional approvals based on UC policy.  To see the salary range for this position (we recommend that you make a note of the job code and use that to look up): TCS Non-Academic Titles Search (https://tcs.ucop.edu/non-academic-titles)   Please note: An offer will take into consideration the experience of the final candidate AND the current salary level of individuals working at UCSF in a similar role.  For roles covered by a bargaining unit agreement, there will be specific rules about where a new hire would be placed on the range.  To learn more about the benefits of working at UCSF, including total compensation, please visit: https://ucnet.universityofcalifornia.edu/compensation-and-benefits/index.html

Department Description

The Office of Medical Affairs and Governance (OMAG) has policy oversight for credentialing and privileging of health care providers, reporting obligations to state/federal licensing boards, and the affiliated community partner groups in the physician network on behalf of the UCSF Health System.  We enroll providers with our contracted health plans and are instrumental in the health system’s billing and revenue operations.  In coordination with the UCSF Office of Legal Affairs, OMAG is also responsible for all medical staff peer review investigations.  

Required Qualifications

• Bachelor’s degree in a related area or four years of relevant experience.
• Three years working in a healthcare environment.
• Knowledge of TJC, NCQA, CMS, DHS, DMHC, ACGME and other applicable accreditation/regulatory requirements.
• Knowledge of managed care, provider enrollment/credentialing, and/or medical staff services.
• Knowledge of relevant healthcare regulations issued by Federal and State entities.
• Ability to interpret health plan enrollment regulations to ensure compliance.
• Competency in a paperless computer environment and understanding of provider data integrity standards (credentialing software, MS Office suite, Adobe Professional, document scanning/storage, web-based applications and tools, etc.).
• Ability to perform all commonly applicable functions in Microsoft Office Suite (Word, Excel, PowerPoint, OneNote, etc.), medical credentialing database application, Epic, and EMR systems.
• Excellent ability to  interact with all levels of management; communicate effectively, both verbally and in writing; and, function within a team and independently.
• Excellent data analysis, research, and reporting skills.
• Exceptional organizational skills and ability to set priorities as well as manage multiple demands effectively.
• Role models and promote best practices to maintain confidentiality and discretion to preserve.
• HIPAA/Peer review protections as well as attorney-client privilege, as warranted.
• Knowledge of compliant revenue/billing practices to mitigate fraud/waste/abuse impacts on organization priorities/work plans.
• The ability to work onsite in our San Francisco office when required.

Preferred Qualifications

Certified Professional Medical Services Management (CPMSM)

License/Certification

Certified Provider Credentialing Specialist (CPCS) within 18 months of hire from OMAG required to meet performance expectations of role.

About UCSF

At UCSF Health, our mission of innovative patient care, advanced technology and pioneering research is redefining what’s possible for the patients we serve – a promise we share with the professionals who make up our team.

Consistently ranked among the top 10 hospitals nationwide by U.S. News & World Report – UCSF Health is committed to providing the most rewarding work experience while delivering the best care available anywhere. In an environment that allows for continuous learning and opportunities for professional growth, UCSF Health offers the ideal atmosphere in which to best use your skills and talents.

Pride Values

UCSF is a diverse community made of people with many skills and talents. We seek candidates whose work experience or community service has prepared them to contribute to our commitment to professionalism, respect, integrity, diversity and excellence – also known as our PRIDE values.

In addition to our PRIDE values, UCSF is committed to equity – both in how we deliver care as well as our workforce. We are committed to building a broadly diverse community, nurturing a culture that is welcoming and supportive, and engaging diverse ideas for the provision of culturally competent education, discovery, and patient care. Additional information about UCSF is available at diversity.ucsf.edu

Join us to find a rewarding career contributing to improving healthcare worldwide.

Equal Employment Opportunity

The University of California San Francisco is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.

Job Code and Payroll Title

005519 MED STF SVC SPEC 3

Job Category

Accounting / Finance, Financial, Government & Public Affairs, Professional (Non-Clinical)

Bargaining Unit

99 – Policy-Covered (No Bargaining Unit)

Location

Embarcadero Street (SF), Hybrid, San Francisco, CA

Additional Shift Details

M-F