Credentialing & Revenue Specialist

About Utah Partners for Health (UPFH)At UPFH, we believe healthcare is a fundamental right. As a non-profit, Federally Qualified Health Center (FQHC), we provide comprehensive care across a dedicated local clinic network. Combining medical, dental and behavioral health clinics with a pharmacy, we're able to treat the whole patient. Together, our multi-site system delivers high-quality, compassionate care to underserved populations across Utah.We are seeking a Credentialing and Revenue Specialist for our team to ensure our providers and clinical staff are credentialed and licensed in compliance with state and federal laws, as well as best practices.Job SummaryThe Credentialing & Revenue Specialist manages provider credentialing and privileging, payer enrollment, and assigned revenue-cycle activities for Utah Partners for Health. This position ensures providers meet organizational, HRSA, Joint Commission, and payer requirements and are appropriately enrolled and ready to bill for services.The position also supports revenue-cycle improvement by resolving enrollment, payer, claim, and reimbursement issues.Role and Responsibilities Clinical Credentialing and Privileging Coordinate initial credentialing, recredentialing, privileging, and re-privileging of providers. Complete and document required primary-source verifications, including licenses, education, certifications, NPDB, exclusions, DEA, and other applicable credentials. Maintain complete, accurate, and survey-ready electronic credentialing files. Track licenses, certifications, privileges, and other expirable credentials. Coordinate credentialing and privileging review and approval with clinical leadership, executive leadership, and the Governing Board as required. Support HRSA, Joint Commission, payer, and other credentialing audits and surveys.Payer Credentialing & Enrollment Enroll providers with Medicare, Medicaid, managed care, and commercial payers. Maintain CAQH profiles and payer enrollment information. Complete recredentialing, revalidation, demographic changes, provider additions/terminations, and location enrollment. Track applications through final approval and confirmed effective date. Maintain accurate payer participation and enrollment records.Revenue Cycle SupportEnsure newly hired providers are credentialed, enrolled, and revenue-ready as quickly as possible. Investigate credentialing and enrollment-related claim denials and payment delays. Assist with payer follow-up, accounts receivable, and revenue-recovery projects. Identify recurring reimbursement issues and escalate significant concerns to the CFO. Assist with payer and revenue-cycle improvement projects as assigned.Tracking & Accountability Maintain centralized tracking of provider credentialing, privileges, payer enrollment, expirations, revalidations, outstanding issues, and revenue-readiness. Outstanding items must include current status, last action, next required action, and target completion date.