Initiates and cultivates partnerships with department management, medical staff and hospital/health plan leadership to ensure compliance and optimal efficiency for appropriate membership and privileges for UCSF Medical Staff, Advanced Health Professionals and CVO contracted facilities (LPPH, School of Dentistry, UCSF Foundation and others, as applicable). First responder to onboarding and revenue channel disruptions as well as performs auditing functions pursuant to facility Bylaws, Rules and Regulations; Credentialing Policy and Procedures; and other applicable accreditation/payor standards (e.g. NCQA, TJC, DHS, DMHC, CMS, delegated credentialing agreements, etc.) Facilitates and supports committees and continuous performance improvement efforts to achieve department and organization goals/workplans. Implements policy and procedures, provides training and orientations to a variety of constituents and supports efforts to sustain best practices.

Requirements:

• Bachelor's degree in a related area or five years of equivalent experience.

• Two years of relevant work experience in a similar environment (i.e.: audit, credentialing, compliance, healthcare, quality, process improvement).

• Proven ability to apply external regulatory guidelines and internal accounting and administrative policies knowledge and skills to assess and monitor compliance and effectiveness of processes.

• Solid skills to evaluate issues and identify solutions. Demonstrated ability to solve problems and suggest solutions through critical thinking processes.

• Ability to independently set and meet deadlines while multi-tasking and assigning precedence to competing priorities. Ability to see multiple assignments through to completion on deadline.

• Skills to work collaboratively coordinate and integrate with others throughout the department, hospital and campus. Ability to communicate through all mediums and with all groups and work under pressure of constantly changing deadlines and priorities.

• Ability to perform all commonly applicable functions in Microsoft Office Suite (Word, Excel, PowerPoint) and medical credentialing database application.

• Thorough knowledge of data management and documentation methods used in medical credentialing.

• Advanced competency in a paperless computer environment and understanding of provider data integrity standards (credentialing software, MS Office suite, Adobe Professional, document scanning/storage, web based applications and tools, etc.)

• Role models and promotes best practices to maintain confidentiality and discretion to preserve

• HIPAA/Peer review protections as well as attorney-client privilege, as warranted.

• Ability to work onsite in San Francisco when required.

Preferences:

• Knowledge of compliant revenue/billing practices to mitigate fraud/waste/abuse impacts on organization priorities/workplans.

• Expert knowledge of TJC, NCQA, CMS, DHS, DMHC, ACGME and other applicable accreditation/regulatory requirements.

• At least one of the below certifications within 18 months of hire):

  • Certified Provider Credentialing Specialist (CPCS)

  • Certified Professional Medical Services Management (CPMSM)

  • Certified Professional in Healthcare Quality (CPHQ

  • Certified Professional Coder (CPC) Pref

Please Note: Work Authorization Notice - We do not provide visa sponsorship or immigration support for this position. Applicants must already be authorized to work in the United States permanently without the need for current or future sponsorship.