Insurance And Credentialing Coordinator

The University of California, Merced is required to provide a reasonable estimate of the compensation range for this role. This range takes into account the wide range of factors that are considered in making compensation decisions including but not limited to experience, skills, knowledge, abilities, education, licensure and certifications, and other business and organizational needs. It is not typical for an individual to be offered a salary at or near the top of the range for a position. Salary offers are determined based on final candidate qualifications and experience. The full salary range for this position is $24.16-$34.32. The budgeted salary or hourly range that the University reasonably expects to pay for this position is $24.16.

Initial applicant review will begin on or around May 3rd, 2023. Posting will remain open until filled.

This union position is represented by the bargaining unit Clerical & Allied Services — CX Teamsters Local 2010.

Remote/Hybrid eligibility: This position may be provided a hybrid schedule for part of the year depending on business operations

The University of California, Merced, is the newest of the University of California system's 10 campuses and the first American research university built in the 21st century. With more than 9,000 undergraduate and graduate students, UC Merced offers an environment that combines a commitment to diversity, inclusion, collaboration and professional development. With bachelor's, master's and doctoral degree programs, strong research and academic partnerships, and community involvement, the UC Merced campus is continually evolving and requires talented, knowledgeable and dynamic educators, researchers, management and staff.

Ranked among the best public universities in the nation by U.S. News and World Report, UC Merced is uniquely equipped to provide educational opportunities for highly qualified students from the San Joaquin Valley and throughout California. The campus enjoys a special connection with nearby Yosemite National Park, is on the cutting edge of sustainability in construction and design and supports the economic development of Merced and the region.

The Merced 2020 Project, a $1.3 billion public-private partnership unprecedented in higher education and completed in 2020, nearly doubled the physical capacity of the campus, enhancing academic distinction, student success and research excellence. UC Merced also operates the Downtown Campus Center, a $33 million, three-story administrative building located in the heart of Merced.

The university’s mission of educational excellence and rigorous inquiry is powered by three schools and numerous research institutes and centers that seek scientific and social solutions for the Valley, California and the world. In partnership with UC San Francisco, UC Merced is preparing the way for a rigorous medical education program.

The course of UC Merced’s evolution is piloted by a long-range strategic plan. Enacted in 2021, the 10-year blueprint is guiding how the values of equity and justice influence our pathway to earning Carnegie R1 research status, growing enrollment, upholding our identity as a minority-serving institution, and operationalizing how commitments to equity, diversity and inclusion are enacted in each campus unit.

Reporting to the Insurance Administration Supervisor, the Insurance and Credentialing Coordinator oversees credentialing for Student Health Services and Counseling and Psychological Services. Credentialing duties include assisting in clinical provider credential and re-credential review in collaboration with UC Risk Services and the contracted Credentials Verification Contractor as well as the monitoring of licenses and expirables for professional staff. In addition to credentialing duties, this position provides support of the campus Student Insurance waiver application process, eligibility, communication with enrollees, working with the waiver and eligibility carrier and may occasionally work with Campus IT and the Registrar's Office. The position provides back-up support for billing. This position may also assist in the front office from time-to-time to support medical reception and medical records duties.

KEY RESPONSIBILITIES

CREDENTIALING:

• Monitor licenses and expirables and notify staff per policy.
• Maintain credential files in accordance with UCOP, UC Merced and accrediting agency protocols and guidelines.
• Review credentialing materials received from applicant for completeness and accuracy.
• Review and prepare materials for submission to Credentialing Committee for review. Forward recommendations to Governing Body for final approval.
• Serve as non-voting member of the Governing Body. Prepare meeting agendas, take minutes, and keep records of all meeting transactions.
• Coordinate credentialing process with internal and external partners.
• Advise clinical managers during review of credentialing files.
• Oversee clinical appointment and reappointment (credentialing and privileging) processes.

INSURANCE PROGRAM:

• Participate in the development of all marketing materials for the health plan, including the official plan document and ID cards prepared by UCOP and the insurance carrier. Plan and oversee the communications with students and parents via direct mail, email, campus signs, brochures and other methods regarding enrollment and waiver processes and deadlines. Participate in outreach activities through student/parent orientation sessions and other informal presentations for students, parents, and campus divisions to effectively communicate plan benefits, policies, procedures and utilization within the Health Center.
• Annually coordinate the insurance plan implementation including waivers, waiver appeals, and student eligibility enrollment working with internal and external partners. Oversee waiver, waiver appeal and eligibility uploads between the campus and external vendor, ensure the transfer of student enrollment data to the insurance carrier(s) before the plan start date; process insurance enrollment applications and waiver requests.
• Coordinate incorporation of benefits, coverage, enrollment, and eligibility, and forms for dependents of registered students with external partners and their administrators, informing students and their dependents of policies and procedures for program.
• Ensure compliance with UC regulations and requirements regarding mandatory insurance for registered undergraduate, graduate, and international students as enacted by the UC Office of the President.
• Reconcile insurance enrollment between the University, campus Banner System, and the insurance carrier. Work closely with Student Business Services regarding student enrollment and waivers and review, authorize, and process charges and refunds to students' accounts as appropriate. Audit insurance invoices and recommend for payment. Maintain a process to identify and reconcile premiums and insurance admin fees and recommend for transfer to department budget.
• Directly advises the Health Insurance Supervisor, Business Operations Manager, and Medical Director on all insurance matters and the Health Center clinical and administrative staff of insurance applicability and regulations to the practice.
• Acts as a liaison between the clinician, outside health care provider, claims processor, and the insured. Investigates any student grievances with insurance companies, claims adjusters, or non-SHS medical providers advocating for a favorable resolution for the student. Develop and maintain good working relationships with healthcare providers, claims and insurance company personnel.
• Coordinate management of Non-Registered Voluntary UC SHIP policies and procedures which require communication of benefits and responsibilities to registered, eligible students, verifying registration statuses with the Registrar and Campus Department, and instating eligibility to external partners.
• Standardize waiver policies and processes which requires monitoring of waiver and waiver appeal activity, communicating to the students and parents of their responsibilities (primary waiver deadlines, waiver appeal process and deadlines, waiver cancellation/enrollment periods), organizing and managing waiver appeals and the delivery of results to students and parent, and determining compliance of private health insurance plans processed to the instated waiver criteria through appeals and audits.

BILLING:

• Establish and maintain billing procedures that comply with state and federal law.
• Ensure/maintain the service cost in the patient management system.
• Inform patients of health services' fees.
• Ensure payments made by patients are posted correctly.
• Coordinate the billing of service claims to insurances.
• Review recommended charts for appropriate coding. Provide the Medical Director and providers with suggested improvements for coding to appropriately reflect the purpose and acuity of the visit.
• Prepare a monthly report of all insurance transactions and cash/insurance payments for services.
• Coordinate e-pay charges with Student Business Services to ensure ongoing coordinated accuracy of the charge master.
• Reconcile the remittance advice from the insurance carrier and post to patient accounts.
• Prepare the billing batch in the electronic patient management system.

MEDICAL RECEPTION/RECORDS:

• Perform various data entry and information retrieval tasks using a computerized patient records system.
• Call in referrals to other health care providers; schedule appointments for consultations, or other services as ordered by the Provider.
• Assist with the completion of forms.
• Screen, sort, and distribute incoming mail. Prepare outgoing mail.
• Answer questions about Health Services, Counseling Services, and/or University policies, procedures, fees, schedules, services, and programs.
• Participate in quality improvement activities, as directed.
• Photocopy and collate various materials, as needed.
• Distribute a variety of forms, informational materials, and medical records.
• Process medical records requests in accordance with current policy; screen incoming requests; print documents as directed and route to provider for review, maintain established rules for protection of confidentiality in release to third parties; prepare related billing invoice.
• Take messages; schedule, reschedule, and cancel appointments with clinic providers, using a computer system. Verify and update demographic and insurance information from patient. Scan insurance card(s) and other appropriate documents into EMR.
• Answers phones and greet patients and others in person; screen calls and visitors to determine nature of request or problem; refer to appropriate staff member.
• Take standard information for billing, administrative, and other purposes.

EDUCATION and EXPERIENCE

• 1 year progressive experience and demonstrated knowledge in clinical/professional credential verification. (Preferred)
• AAPC Certified Coder certification. (Preferred)
• Bachelor's Degree in Business Administration, Medical Administration, or other related field. (Preferred)
• Certified Credentialing Specialist. (Preferred)
• 1 year experience in health insurance administration including claims processing. (Preferred)
• High school diploma and/or equivalent certification/experience/training. (Required)
• 3 years progressive experience working in a medical environment. (Required)

CRITICAL KNOWLEDGE AND SKILLS

• Ability to work independently and seek out resources. Ability to establish and maintain effective working relationships.
• Effective communication skills, both oral and written. Strong interpersonal skills and a demonstrated ability to work effectively with diverse constituents.
• Demonstrated commitment to customer service and student development.
• Strong computer skills including financial analysis and reporting writing. Ability to use computer and learn new software programs.

Background check and fingerprinting will be required.

How to Apply:
An online application is required for each position to apply.The University of California, Merced is aware that some web-based application processes may be cumbersome for differently abled applicants. Where appropriate, alternative accommodations will be provided. For applicants with disabilities who need additional assistance using TAM, or reasonable accommodations during the interview or search process, please contact [email protected].

Equal Employment Opportunity:
The University of California, Merced is an Equal Opportunity/Affirmative Action employer advancing inclusive excellence. All qualified applicants will receive consideration for employment without regard to race, color, creed, religion, national origin, citizenship, sex, age, marital status, sexual orientation, gender identity or expression, disability, pregnancy, or status as a disabled veteran or Vietnam-era veteran, or other protected categories covered by the UC Nondiscrimination and Affirmative Action Policy. UC Merced intentionally promotes and maintains a discrimination- and harassment-free workplace by demonstrating it neither condones nor tolerates employment practices that discriminate against or harass any person or specific group of persons on the basis listed above. We seek candidates who will support our vision to cultivate a vibrant, equity-minded, inclusive excellence university community. When applying to UC Merced, we strongly encourage you to reflect on our Principles of Community and our 2021 strategic plan.

Vaccination Program Policy:

As a condition of employment, you will be required to comply with the University of California SARS-CoV-2 (COVID-19) Vaccination Program Policy. All Covered Individuals under the policy must provide proof of Full Vaccination or, if applicable, submit a request for Exception (based on Medical Exemption, Disability, and/or Religious Objection) or Deferral (based on pregnancy) no later than the applicable deadline. For new University of California employees, the applicable deadline is 14 days after their first date of employment.

Smoke and Tobacco Free Policy:
The University of California, Merced is a smoke and tobacco free workplace. Information and the Smoke and Tobacco Free policy is available at http://smokefree.ucmerced.edu.

E-Verify:
All employers who receive Federal contracts and grants are required to comply with E-Verify, an Internet-based system operated by the Department of Homeland Security (DHS) in partnership with the Social Security Administration (SSA). E-Verify electronically verifies employment eligibility by comparing information provided on the I-9 form to records in the DHS and SSA databases. Certain positions funded by federal contracts/subcontracts requires UC Merced to notify job applicants that an E-Verify check will be conducted and the successful candidate must pass the E-Verify check.

Pay, Benefits & Work Schedule:
For information on the comprehensive benefits package offered by the University of California visit: http://ucnet.universityofcalifornia.edu/compensation-and-benefits/

This position is eligible for the UC Merced Employee Referral Program (ERP). If you were referred by a UC Merced employee, please identify that employee by name in your application as follows:

Step 5 of 7 (on the application) Referrals

How did you hear about the job? (select) “other”

Additional information? (select) “other”

Specific Referral Source? (write in) first and last name of referring employee

Referring employee MUST be named on application for eligibility.