Job Descriptions
Serves as a resource to assist with provider education, escalated billing and policy issues.
Who are our Provider Relations Consultants?
A method Provider Relations Consultants are employing for provider engagement.
What are the Provider Relations Seminars?
This person oversees professional contracts in Northern Utah and Idaho.
Who is Brenda?
The process of assessing and validating qualifications of a provider.
What is credentialing?
A tool that members use via online or printed to choose a provider.
What are Provider Directories?
This person reviews provider applications, analyzes provider networks and negotiates rates with providers.
Who is the Contracting Executive?
This department performs Initial & Recredentialing activities for all participating facilities & providers.
Who is the Credentialing Department?
This person oversees the intake of UUHP provider applications and application denials.
Who is MJ?
Recredentialing must be completed every ___ years.
What is every three years?
The primary external contact for our network responsible for building relationships with our healthcare providers.
Who are our Provider Relations Consultants?
This person coordinates contracts, W-9s and emails from and for MHC.
Who is Nahui?
This department monitors sanctions including license issues for network providers.
Who is the Credentialing Department?
The provider network offered only in Salt Lake County used by Individual Exchange members.
What is U Health Plus?
Initial credentialing must occur before this can happen.
What is prior to a facility/provider’s participation in a network?
Contract IDs are assigned to vendor records by these employees.
Who are the Provider Data Management Coordinators?
Maintains the integrity in EPIC of our provider and vendor data.
Who are our Provider Data Manager Coordinators?
This Department recently completed an initiative to transfer provider applications from low tech paper and pdf to an on-line application.
What is the Contracting Department?
A new Network Plan serving children beginning July 1, 2024.
What is Healthy U CHIP?
Once a provider becomes contracted, this next step occurs.
What is complete a CAQH/Facility application?
Shows us provider network participation status.
What is Provider Genie?
This role is responsible for Delegation Audits and Oversight.
What is a Sr. Provider Credentialing Consultant?
This Department is working on developing a Children's Health Insurance Program provider network which will begin July 1, 2024
What is the Contracting Department?
Also knowns as (A.K.A) Healthy Options Medical Excellence.
What is H.O.M.E?
A provider or facility is considered an in-network provider as of this date.
What is Credentialing Approval date?
The initial point of contact for escalated inquiries from internal departments for billing and policy or service issues.
Who is the Provider Internal Specialist?