As a patient-focused organization, University of Utah Health exists to enhance the health and well-being of people through patient care, research and education. Success in this mission requires a culture of collaboration, excellence, leadership, and respect. University of Utah Health seeks staff that are committed to the values of compassion, collaboration, innovation, responsibility, integrity, quality and trust that are integral to our mission. EO/AA

This position for use in Health Plans Departments only. This position evaluates provider applications and assesses criteria for participation in U of U Health Plans networks. This position also coordinates provider and facility contracts in the contract management system to ensure appropriate implementation of contract terms, provider data and related credentialing activities. This position will also coordinate with other teams or departments, clients and providers as necessary to effectuate contract terms and changes. Additionally, this position responds to internal staff and external provider inquiries related to network participation, network declination, payment and other related items.

Corporate Overview: University of Utah Health is an integrated academic healthcare system with five hospitals including a level 1 trauma center, eleven community health centers, over 1,600 providers, and a health plan serving over 200,000 members. University of Utah Health is nationally ranked and recognized for our academic research, quality standards and overall patient experience. In addition to our clinical delivery system, we have a School of Medicine, School of Dentistry, College of Nursing, College of Pharmacy, and College of Health providing education and training for over 1,250 providers annually. We have over 2 million patient visits annually and research grants exceeding $350 million. University of Utah Hospitals and Clinics represents our clinical operations for the larger health system.

Essential Functions

• Monitors, responds to and resolves internal staff and external provider inquiries related to network participation, network declination, payment terms, and other related items.
• Screens provider network applications and applies criteria to determine network eligibility. Sends out network application denials and maintains contract tracking system.
• Coordinates with internal and external parties to effectuate contract changes.
• Maintains and files paper and electronic contracting folders to ensure consistent formatting and completeness.
• Updates provider demographic information to the provider database.
• Additional responsibilities, as assigned.

Knowledge / Skills / Abilities

• Excellent interpersonal, problem solving, and verbal and written communication skills.

• Ability to effectively convey information and collaborate with providers, billing staff, internal health plan staff, health plan management, governmental agency personnel, and/or other applicable customers as assigned.

• Detail oriented with problem-solving abilities.

• Ability to be self-motivated.

• Demonstrated Intermediate skills in Microsoft Outlook, Microsoft Word, Microsoft Excel and Microsoft PowerPoint.

• Demonstrated ability to prioritize tasks and determine the order of importance.

• Ability to multi-task and remain highly organized in a fast-paced environment.

• Demonstrated knowledge regarding insurance plans (Medicare, Medicaid, commercial) credentialing, provider contracting, medical billing and coding and contract compliance.

• Demonstrated ability to perform the essential functions of the job as outlined in the job description.

Required

• Bachelor's degree in a health or business-related discipline, or equivalency.

Preferred

• Experience with contract management systems.
• At least two years’ experience in a health insurance company or similar entity.

Working Conditions and Physical Demands

Employee must be able to meet the following requirements with or without an accommodation.

• This is a sedentary position in an office setting that may exert up to 10 pounds and may lift, carry, push, pull or otherwise move objects. This position involves sitting most of the time and is not exposed to adverse environmental conditions.