Additional Info

General Position Information

Position Number: 00090836	Working Title: Provider Credential Associate
Department Name: MMI Patient Information Office UNMC	Reports To Title: Provider Enroll/Authorization Supervisor

Position Description Details

Responsibilities and Duties

RESPONSIBILITY	TIME SPENT PERCENTAGE	ESSENTIAL FUNCTION	TASKS
Provider Credentialing	50	X	Assists in coordinating all insurance contracts and provider enrollments (E) Preparing credentialing packets and coordinating with all MMI health care providers to complete and submit all credentialing paperwork for network participation (E) Performing online provider enrollments where applicable. (E) Performing primary source verification on providers to ensure compliance with all payor guidelines (E) Keeping all payer and provider files up to date, to ensure facility’s accreditation and to assist auditors (E) Assists in ensuring that providers and facility are in compliance with relevant regulations (E) Preparing and maintaining reports of all credentialing activities (E)
Coordinates Insurance authorizations for clinical service	35	X	Works with Insurance companies to understand authorization requirements for clinical services. (E) Assists providers in completing paperwork for authorizations of clinical services. (E) Ensures that appropriate authorizations are on file for all clinical services. (E)
Charge Review	10	X	Reviews charges in work queues to verify that appropriate authorization requirements are attached. (E) Assists in reviewing charge work queues for appropriate modifiers and makes corrections as needed/or coordinates with billing provider to amend the medical record to support clinical billing. (E) Coordinates with Nebraska Medicine (NM) Patient Financial Services (PFS) Billing agent to provide information needed to appeal claims denials. (E) Supports physicians and other health care providers in professional fee billing services. (E)
Other Duties as Assigned	5	X	Provides general clerical support to PIO (E)

Zone Definition Factors

Impact

How quickly is the overall correctness of the work of an incumbent in this position typically determined?:

Determined within a relatively short period of time

Include budget dollars, value of assets, and impact in terms of organizational exposure to risk/liability.

Describe the budgetary accountabilities for this position:

What impact do the decisions/recommendations made by the position have on the department/campus?:

Provider enrollment allows for reimbursement of medical services. If the providers are not enrolled, we receive NO reimbursement for services provided.

Contacts and Communications

TYPE OF CONTACT	LEVEL OF CONTACT	FREQUENCY OF CONTACT	PURPOSE OF CONTACT
MMI Faculty and Staff	Within Department	Daily	Coordinate provider enrollments
Insurance Company Provider reps	External to UNMC	Daily	To coordinate provider enrollments
NM Patient Financial Services	External to UNMC	Monthly	Support appeals for claims denials
Billing agent	Internal to UNMC	Weekly	To coordinate Billing activities, and interact as a liaison with MMI Billing providers

Supervision Received

The position works under general supervision, with assignments based on departmental goals. Employees are expected to manage routine duties and projects independently, with progress reviewed through regular meetings and periodic evaluations.

Supervision Exercised

Does this position supervise?:

Type of Supervision Exercised:

No Supervision:
This role does not have supervisory responsibilities but may work collaboratively with colleagues and offer informal guidance when appropriate.

Work Environment & Physical Demands

Working Environment

Office

Activity Frequency

Sit: Continually (67-100%)	Bending: Occasionally (1-33%)
Stand: Occasionally (1-33%)	Kneeling: Not Required
Walk: Occasionally (1-33%)	Reaching: Occasionally (1-33%)
Drive Motor Vehicle: Not Required	Crawling: Not Required
Squatting: Not Required	Climbing: Not Required

If other, please explain:

N/A

Lift, Carry, Push, Pull Activity

Lift: Occasionally (1-33%) 10 lbs	Push: Occasionally (1-33%) 10 lbs
Carry: Occasionally (1-33%) 10 lbs	Pull: Occasionally (1-33%) 10 lbs

If other Lift, Carry, Push, Pull, please explain:

N/A

Exposure

Animals (Category 1): NO	Moving Machinery: NO
Animals (Category 3): NO	Biohazardous Material: NO
Blood & Bloody Fluids: NO	Uncomfortable temperature/ humidity: NO
Radiation/ Radioactive: NO	Noise: NO
Chemical Hazards: NO	Working from Heights: NO
Electrical Hazards: NO	Confined Space: NO
3B or Class 4 Laser: NO	Dust and Dusty environments: NO
Hot Work: NO

If other exposure, please explain:

N/A

Use of Protective Equipment

Hearing Protection: NO	Eye Protection: NO
Half or Full Face Reusable Respirator: NO	Protective Clothing: NO

If other protection, please explain:

N/A

Use of Hands/ Wrists

Keyboard: YES	Pipefitting: NO
Fine Manipulation: YES	Grasping: NO
Repetitive Motion: YES

If other use of hands/ wrists, please explain:

N/A

Sensory

Ability to Speak: YES	Depth Perception: NO
Hearing: NO	Distant Vision: NO
Sight: YES	Near Vision: NO
Color Vision: NO	Peripheral Vision: NO

Emergency Conditions

During emergency conditions due to severe weather, natural disasters, major utility failures, or other unplanned events, certain personnel are activated to minimizethe impacts of emergencies and disasters, and to protect people, property, and restore the primary mission of the University of Nebraska Medical Center.These personnel occupy positions which are designated as 'Essential Positions.'

Essential: