Responsible for performing credentialing activities to ensure that UPA has a provider network of the highest quality.

Essential Functions Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1. Responsible for the timely processing and tracking of credentialing and recredentialing files.

2. Review credentialing and recredentialing files for accuracy and completeness. Perform primary source verification of practitioner credentials based on the policies and procedures of UPA and the federal and state regulatory agencies and accrediting bodies.

3. Monitor and assist further investigations as deemed necessary during the credentialing and recredentialing process by document evaluation, primary source verifications or as requested from UPA Membership Committee and Membership Committee Chair.

4. Prepare credentialing and recredentialing files for the Medical Director and/or the UPA Membership Committee.

5. Responsible for completing all practitioner files by committee date as assigned.

6. Works closely with Provider Contracting and Provider Enrollment to ensure the credentialing application process is efficient and meets established turnaround times.

7. Attend monthly Membership Committee meetings and act on the decisions of the Committee regarding files processed.

8. Participate in preparation of payer delegated credentialing audits as required by NCQA.

9. Attend and participate in staff meetings.

10. Maintain confidential credentialing and recredentialing files and electronic credentialing database.

11. Participate in credentialing team quality audits.

12. Participate in the development and implementation of departmental policies, procedures, forms, etc.

13. Perform site visits as necessary or requested.

14. Other duties as assigned.

This is a full-time position. Days of work are Monday through Friday. Hours are typically anywhere between 7:00 a.m. to 5:30 p.m. Evening and weekend work may be required as workload demands.

Position has the ability to take advantage of our work-from-home setup. However, candidate must be able to commute to Knoxville, TN for required on-site training period or intermittently as needed. This position may require some travel for meetings, seminars and any other off site work functions. Travel is primarily local during the business day, although some out-of-the-area and overnight travel may be expected.

Full benefit package available, including PTO, Medical, Dental, Vision, STD, LTD, Life Insurance, 401k, and more!

• Good oral and written communication skills.
• Ability to meet scheduled deadlines with minimal supervision
• Strong organization skills and accurate work results.
• Ability to maintain a professional demeanor and confidentiality.
• Maintain knowledge of CMS, NCQA, State and Federal regulations related to health plan credentialing activities.
• Detail oriented.
• Accomplish responsibilities accurately and expeditiously.
• Ability to multi-task and deal with complexity on a frequent basis.
• Flexible, team player.
• Self-starter and self-motivated, functions independently with minimal direction.
• Word processing and database computer skills, including Word and Cactus, preferred.
• Must be able to work with a variety of people and under varying circumstances.
• Commitment to the values of the UPA and the Managed Care Department.

Required Education and Experience

High School Diploma or equivalent required. Associate's degree preferred.

Minimum four (4) years' experience in a healthcare delivery environment or three (3) years in credentialing activities.

Preferred Education and Experience

Certified Provider Credentialing Specialist (CPCS) or Certified Professional Medical Services Management (CPMSM) preferred. If not certified, must obtain certification within one year of hire date.

While performing the duties of this job, the team member is occasionally required to stand; walk; sit; reach with hands and arms; climb stairs; balance; stoop, kt;1eel, or crouch. The team member must occasionally lift or move up to 25 pounds.