The Credentialing Specialist will be responsible for the following::
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.
Tenet Healthcare/USPI complies with federal, state, and/or local laws regarding mandatory vaccination of its workforce. If you are offered this position and must be vaccinated under any applicable law, you will be required to show proof of full vaccination or obtain an approval of a religious or medical exemption prior to your start date. If you receive an exemption from the vaccination requirement, you will be required to submit to regular testing in accordance with the law.
Primary Location: Dallas, Texas
Facility: Tenet Physician Resources
Job Type: Full-time
Shift Type: Days
Employment practices will not be influenced or affected by an applicantâ��s or employeeâ��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.
Tenet Healthcare Corporation (NYSE: THC) is a diversified healthcare services company headquartered in Dallas with 112,000 employees. Through an expansive care network that includes United Surgical Partners International, we operate 65 hospitals and approximately 510 other healthcare facilities, including surgical hospitals, ambulatory surgery centers, urgent care and imaging centers and other care sites and clinics. We also operate Conifer Health Solutions, which provides revenue cycle management and value-based care services to hospitals, health systems, physician practices, employers and other clients. Across the Tenet enterprise, we are united by our mission to deliver quality, compassionate care in the communities we serve.