Med Stf SVC Spec 3

This position will serve as a processing analyst for the University analyzing evaluating processing and selfaudits applications according to appropriate membership privileges and health plan enrollments for UCSF Medical Staff Advanced Practice Professionals and CVO contracted facilities (LPPH&C School of Dentistry UCSF Benioff Childrens Physicians (UBCP) Clinically Integrated Network (CIN) Partners Benioff Childrens Hospital Oakland and others as applicable). This position will also process provider enrollment applications for UCSF billing physicians Advanced Practice Providers and Clinical Partners/Affiliates. This position will ensure all provider health plan enrollment applications are accurate and compliant. Implements policy and procedures provides training and orientations to various constituents and supports efforts to sustain best practices.

• Manage and perform administrative and analytical tasks to credential new and reappointing providers who apply/reapply to practice at UCSF or within UCSF Health network. Ensure file completeness analyzing for time gaps checking appropriate licensure obtaining peer references and verifying additional required credentialing items. Reconciling and resolving discrepant information obtained during the credentialing process is of the utmost importance. Consistent communication with applicants colleagues and management is crucial. Additionally the credentialing process may also require liaising with other teams various UCSF departments/managers to ensure an integrated timely and accurate credentialing workflow.
• 2 Prepares and submits provider health plan enrollment applications for new enrollments and revalidation with government and commercial plans. Prepares and submits Deactivation once the provider is no longer active with UCSF and has been approved for deactivation by the Governing bodies.
• 3 Oversee/monitor submitted provider enrollment applications monitor necessary follow ups with appropriate entities responding to Requests for Information (RFI) and obtaining signature pages and all necessary documentation for the submission of various documents in the health plan enrollment process.
• 4 Collaborates with the Director and Program Manager to help improve business operations credentialing practice enrollment practice and systems interface.
• 5 Works directly with the intermediaries of the Center for Medicare/Medicaid Services (CMS) The Department of Health Care Services (DHCS) and California Childrens Services (CCS) to ensure submitted applications are processed correctly and in a timely manner.
• 6 Monitors and manages Medicare and MediCal revalidation applications on a random cycle of all existing billing providers Groups/Suppliers and UCSF Tax Identification Numbers (TIN).
• 7 Interprets and understands current and forthcoming health plan enrollment regulations issued by Federal and State entities to ensure compliance for the University and UCSF Medical Staff Providers.
• 8 Manage providers primary specialty in ECHO and manage updates in National Provider Identifier (NPI) Registry such as Name change Primary Specialty Taxonomy and Primary practice location (Group name address phone and fax number).
• 9 Supports credentialing work queues to avoid and/or resolve health plan enrollment/credentialing related claim denials.
• 10 Works closely with billing agents to resolve/release held claims in credentialing work queues.
• 11 Works with billing agents and departments to ensure proper billing practice.

This position is responsible for ensuring all Physician and NonPhysician profiles are accurately updated and correctly reflect credentialing and health plan enrollment statuses. Deficiencies in profiles would result in misguided information across the entire facility improper healthcare access and potential loss of revenue.
1 Monitors and reports potential enrollment delays to department representatives billing agents and leadership.

Ensures all outside UCSF Affiliates and Clinical Partners are appropriately credentialed and enrolled with government health plans including Medicare MediCal and California Children Services.

Using effective decision making and problemsolving skills the position is responsible for implementing functional credentialing and health plan enrollment (HPE) work flows and reporting on those functions. The incumbent must be cognizant of and able to work with the regular fluctuations in documentation healthcare regulations as well as the ongoing development and implementation of UCSF IT systems.

The incumbent must work closely with billing agents (Medical Group Business Services Change Healthcare) government agencies and their systems/platforms (CMS DHCS PECOS PAVE NPPES EDS) intermediaries (Noridian) and commercial health plan contracts to ensure credentialing and enrollment compliance and proper billing practices.


The final salary and offer components are subject to additional approvals based on UC policy. Thesalary range for this position varies from $63700$136100 and the target entry point is $76800 based on experienceAND the current salary levels and experience of individuals working at UCSF in a similar role. To learn more about the benefits of working at UCSF including total compensation please visit: degree in a related area or four years of relevant experience.