Job Description

University of Utah Job Description

Job Summary

Responsible for a broad range of credentialing functions that include reviewing, analyzing, evaluating, and processing applications for public school teaching credentials, certificates and permits. Serves as a campus resource and provides assistance, guidance and current information to students, members of the faculty, faculty committees and other interested parties on matters regarding State and campus credentialing requirements. Facilitates the centralized credentials verification program and system wide practitioner credentialing database and serves as the primary credentialing liaison for hospitals, clinics and practitioner related issues.

Qualifications

Associates degree in a related area of assignment or equivalency plus three years experience as professional support in the medical field required. Experience with Word, Excel and use of data management systems and demonstrated human relation and effective communication skills also required.

This position has no responsibility for providing patient care.

Applicants must demonstrate the potential ability to perform the essential functions of the job as outlined in the position description.

Disclaimer

This job description has been designed to indicate the general nature and level of work performed by employees within this classification.  It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities and qualifications required of employees assigned to the job.

Essential Functions

1. Sends appointment and reappointment application packets to practitioners or School of Medicine departments with appropriate, facility specific, privilege delineation forms.
2. Creates and maintains practitioner files.
3. Receives back the initial appointment and reappointment applications, ensures they are appropriately signed, assuring completeness, enters data into the credentialing software and verifies credentials from the primary source as outlined on the application.
4. Assembles completed appointment packets for each approval by Credential Committees, Medical Board and Hospital Board.
5. Coordinates reappointment dates and sends out application packets for all practitioners participating in the centralized credentials verification program.
6. Receives back the reappointment applications, ensures they are appropriately signed, assuring completeness, enters data into the credentialing software and verifies credentials from the primary source as outlined on the application regarding any new or changed information.
7. Prepares credentials profile and assembles completed reappointment packets for each approval by Credentials Committee Medical Board and Hospital Board.
8. Runs monthly queries for any information, license or certification that may expire and maintains current documentation in database and credentialing file.
9. Communicates with SOM, UNI and Community Clinics regarding status of applications on an ongoing basis.
10. Contacts medical office staff, licensing agencies, and insurance carriers to complete credentialing and recredentialing applications.
11. May coordinate audits with payers in accordance with delegated credentialing agreements.
12. May send policies, documents and forms to payers upon request in preparation for audit.
13. May pull files from random sample of practitioner names and perform an internal file review prior to audit.
14. May audit files with payers.
15. May reviews policies and documents with payers and follows up with any corrective action plan.
16. May provide monthly, quarterly and/or annual reports to payers in accordance with credentialing delegation agreements.
17. May communicate with UUMG on an ongoing basis as to status of delegations.

Problem Solving

The incumbent is responsible for obtaining the necessary information and documentation from practitioners in a timely manner and interacting with physicians, other practitioners, payers and health care facilities in an assertive and professional manner. Incumbents are expected to credential practitioners in compliance with DNV, NCQA and URAC credentialing standards.