Credentialing Specialist TPR (Dallas, TX)

Credentialing Specialist:

• Have knowledge of NCQA standards, delegated credentialing and Primary Source Verification.
• Have knowledge of health plan credentialing and enrollment including Medicare and Medicaid.
• Have ability to prepare and/or update the providerâ��s CAQH application for newly affiliated and existing healthcare providers for initial and recredentialing activity.
• The ability to build and maintain peer-to-peer relationships with all relevant market and national health plans.
• Establish credentialed status to facilitate billing for multiple specialties.
• Maintain and update credentialing databases completely and accurately and ensures up-to-date tracking of file process.
• In-depth working knowledge of the various applications associated by plan as well as internally and the workflow process defined by department leadership.
• Ensure all workflow items are completed within the set turn-around-times, meeting quality expectations.
• Roster management and reporting experience preferred

• Minimum of two years of experience in a credentialing role or related health care environment, such as credentialing or file maintenance preferred.
• Understanding of Medicare and Medicaid enrollment (multiple states) as well as experience in navigating government portals preferred.
• Knowledge of health plan credentialing, enrollment and requirements .
• Knowledge of CAQH.
• Baseline knowledge of revenue cycle.
• Ability to work within a deadline-intense environment.
• Demonstrated problem-solving and customer service skills.
• Knowledge of Microsoft Word and other PC applications.
• High School Diploma or equivalent required; completion of an applicable Vocational or Technical training program preferred.
• Excellent verbal and written communication skills.

Employment practices will not be influenced or affected by an applicant�s or employee�s race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, sexual orientation, gender identity or expression, veteran status or any other legally protected status. Tenet will make reasonable accommodations for qualified individuals with disabilities unless doing so would result in an undue hardship.