Provider Demographic Specialist
Health Care that Starts with You!
Join a truly mission-driven organization! Independent, nonprofit UCare is recognized as one of the Minnesota's leading health plans. We provide more than 225,000 members across Minnesota and western Wisconsin with the health coverage plans and services they need to maintain and improve their health. The innovative coverage we create makes a difference for Medicare-eligible individuals, individuals and families enrolled in Minnesota Health Care Programs, such as MinnesotaCare and Medical Assistance, and disabled adults with special health care needs. UCare is growing in size, membership, products, geographic coverage, and employees. We're an organization that's going places. Be part of a team that cares about you, be part of UCare.
ABOUT UCAREAt UCare, we deliver high-quality health coverage and services to help members of all ages maintain and improve their health. It's a big job that takes innovative ideas, strategic partnerships, and a commitment to doing the right thing. Above all, it takes a compassionate team that is dedicated to making a real difference in the lives of our members and our communities. WORKING AT UCAREWorking at UCare is more than just 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. Our values of integrity, community, quality, flexibility, and respect permeate every aspect of our organization - from who we are and how we act, to what we do and how we do it. We owe our continued success to our employees who proudly embody our mission and values in everything they do. PROVIDER DEMOGRAPHIC SPECIALIST
Position DescriptionThis 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. Specific duties and responsibilities include: 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.EducationHigh school graduate or equivalent. Certified Provider Credentialing Specialist (CPCS) or Certified Medical Staff Coordinator Certification preferred.Required ExperienceTwo 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.Preferred ExperienceExperience in a clinic business office, insurance or HMO environment. Delegation of Credentialing/Recredentialing and/or credentialing/recredentialing experience.THE UCARE DIFFERENCEUCare is proud to be a recognized Star Tribune Top Workplace for the 9th consecutive year. As a part of our collaborative team, you'll experience the rewards that come with helping others and seeing the positive results of your hard work. We value and respect each individual's ideas and contributions, and give you the freedom to grow both personally and professionally. We are centrally located, and offer onsite education, equipment and wellness resources, a myriad of volunteer activities, and a number of other rewards. If you're looking for a welcoming environment that celebrates what you have to offer, 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.
Enter a highly collaborative environment where people are truly engaged, and feedback is valued. You'll enjoy a competitive salary and benefits, as well as a host of other perks, including a nationally recognized wellness program, and a bright, open, award-winning office space in Northeast Minneapolis just minutes from major freeways and retail centers.
At UCare, we welcome and employ a diverse employee group committed to meeting the needs of UCare, our members, and the communities we serve.