UCare offers Medicare, Medicaid, Individual and Family health plans – powered by the hardest working people in the industry. Our people powered teams de-complicate, advocate and always go the extra mile to help our members. We serve with integrity, compassion and commitment to do right by members, providers and government partners. Above all, we come to work excited to provide members a path for the best health of their lives.
WORKING AT UCARE
Working at UCare is more than a career; it's a mission. A mission that defines us as professionals, unites us as an organization and shapes how we interact with our members and each other. Employees join UCare and stay because of the opportunity to have a purpose-driven job.
Our strong culture has established UCare as a Star Tribune Top 150 Workplace for 12 consecutive years since the awards program began. It’s a culture that embraces innovative ideas, strategic partnerships, and exemplary customer and provider experiences. Working at UCare is being a part of a people powered team dedicated to making a real difference in the lives of our members and communities.
PROVIDER DEMOGRAPHIC SPECIALIST
Work Location: Work From Home
The health and safety of our employees, members, providers, and our community is our highest priority. Therefore, all new employees are expected to be fully vaccinated against COVID-19 prior to starting at UCare, subject to limited exceptions such as for a sincerely held religious belief or for medical reasons.
This position is responsible to ensure the integrity of delegate data in the credentialing database by following NCQA, CMS and MDH standards. Enter accurate data into the credentialing database using the data submitted by providers to ensure the accuracy of provider directories and Find A Doc.
· Maintain NCQA Standards as well as state and federal requirements for provider data in the credentialing database as well as other appropriate databases as necessary to ensure accurate provider data for members in directories and Find A Doc.
· Research, analyze and process ATC forms, Service Forms and PEC online forms.
· Ensure the integrity of all delegated profiles in which they meet the NCQA, CR, Standards as well as state and federal requirements.
· Remain current with credentialing requirements of regulatory agencies including NCQA, CMS and MDH.
· Identify any delegated practitioners that do not meet UCare’s criteria and present findings to the Delegated Coordinator/Credentialing Manager.
· Research and provide appropriate written and verbal communication to delegates, team members, and director regarding issue identification and resolution.
· Maintain timely communication with external providers regarding the eligibility and credentialing decisions and/or related provider issues.
· Other projects and duties as assigned.
High school graduate or equivalent. Certified Provider Credentialing Specialist (CPCS) or Certified Medical Staff Coordinator Certification preferred.
Two years of relevant experience in health care related field. PC experience including spreadsheet and word processing; preferably Microsoft Access, Excel and Word. Understanding of the Credentialing process.
Experience in a clinic business office, insurance or HMO environment. Delegation of Credentialing/Recredentialing and/or credentialing/recredentialing experience.
THE UCARE DIFFERENCE
The UCare difference is our people power – employees actively working on the behalf of our members to get them access to the health care they need. We value and respect each individual's ideas and contributions, and provide the freedom to grow both personally and professionally. We are centrally located, and offer onsite education, equipment and wellness resources, and a myriad of volunteer activities. If you're looking for an inclusive environment that celebrates your people power, helps you build on your strengths and gives you the opportunity to truly make a difference, we invite you to apply.
As an Equal Opportunity/Affirmative Action Employer, we welcome and employ a diverse employee group committed to meeting the needs of UCare, our members, and the communities we serve.
JOB POST DATE: 4/5/2022