Credentialing & Revenue Specialist

Description

About Utah Partners for Health (UPFH)

At UPFH, we believe healthcare is a fundamental right. As a non-profit, Federally Qualified Health Center (FQHC), we provide comprehensive care across a dedicated local clinic network. Combining medical, dental and behavioral health clinics with a pharmacy, we're able to treat the whole patient. Together, our multi-site system delivers high-quality, compassionate care to underserved populations across Utah.

We are seeking a Credentialing and Revenue Specialist for our team to ensure our providers and clinical staff are credentialed and licensed in compliance with state and federal laws, as well as best practices.

Job Summary

The Credentialing & Revenue Specialist manages provider credentialing and privileging, payer enrollment, and assigned revenue-cycle activities for Utah Partners for Health. This position ensures providers meet organizational, HRSA, Joint Commission, and payer requirements and are appropriately enrolled and ready to bill for services.

The position also supports revenue-cycle improvement by resolving enrollment, payer, claim, and reimbursement issues.

Role and  Responsibilities 

Clinical Credentialing and Privileging 

•  Coordinate initial credentialing, recredentialing, privileging, and re-privileging of providers.
•  Complete and document required primary-source verifications, including licenses, education, certifications, NPDB, exclusions, DEA, and other applicable credentials.
•  Maintain complete, accurate, and survey-ready electronic credentialing files.
•  Track licenses, certifications, privileges, and other expirable credentials.
•  Coordinate credentialing and privileging review and approval with clinical leadership, executive leadership, and the Governing Board as required.
•  Support HRSA, Joint Commission, payer, and other credentialing audits and surveys.

Payer Credentialing & Enrollment

•  Enroll providers with Medicare, Medicaid, managed care, and commercial payers.
•  Maintain CAQH profiles and payer enrollment information.
•  Complete recredentialing, revalidation, demographic changes, provider additions/terminations, and location enrollment.
•  Track applications through final approval and confirmed effective date.
•  Maintain accurate payer participation and enrollment records.

Revenue Cycle Support

• Ensure newly hired providers are credentialed, enrolled, and revenue-ready as quickly as possible.
•  Investigate credentialing and enrollment-related claim denials and payment delays.
•  Assist with payer follow-up, accounts receivable, and revenue-recovery projects.
•  Identify recurring reimbursement issues and escalate significant concerns to the CFO.
•  Assist with payer and revenue-cycle improvement projects as assigned.

Tracking & Accountability

•  Maintain centralized tracking of provider credentialing, privileges, payer enrollment, expirations, revalidations, outstanding issues, and revenue-readiness. 
•  Outstanding items must include current status, last action, next required action, and target completion date. 

Requirements

Qualifications

Education and Experience

• Two or more years of healthcare credentialing, provider enrollment, billing, revenue-cycle, or      related experience preferred. 
• Knowledge of provider credentialing, CAQH, Medicare, Medicaid, and commercial payer enrollment.
• Knowledge of HRSA and Joint Commission credentialing requirements preferred.
• FQHC and eClinicalWorks experience preferred. 

Knowledge, Skills, and Abilities

• Strong organizational and documentation skills.
• Exceptional attention to detail.
• Demonstrated ability to manage multiple deadlines simultaneously.
• Strong written and verbal communication skills.
• Abiltiy to handle confidential provider and organizational information appropriately.
• Proficiency with Microsoft Office and electronic recordkeeping systems. 

This position will start as Part-Time with potential to become Full-Time as the specialist develops the position and the organization grows.