Credentialing Coordinator | Full Time

Peterson Health; Kerrville (TX); On-site; USD 45,000 - 70,000; Full time

Benefits offered by this job

Health Insurance

401(k)

Dental Insurance

Vision Insurance

Paid time off

Tuition Reimbursement

Employee Education Scholarships

Employee Referral Program

Merit Increases

Free onsite fitness facility

Job summary

Peterson Health, a not-for-profit rural community hospital in Kerrville, TX, seeks a Credentialing Coordinator to verify credentials for PRHCN members and affiliated providers, ensuring NCQA and CMS compliance. The role involves submitting enrollment applications and coordinating with payer credentialing teams to maximize payer participation and revenue cycle accuracy.

Preferred candidates hold an Associate or Bachelor’s in healthcare management and have at least 2 years in payer relations or

Qualifications

• Associates or Bachelor’s degree in healthcare management.
• Proficient in Microsoft Office and strong communication.
• Minimum 2 years payer relations or credentialing experience.

Responsibilities

• Credentialing verification for Peterson Regional Healthcare Network (PRHCN) members and affiliated providers to ensure NCQA/CMS/TMHP compliance.
• Submit accurate enrollment applications and follow up with payer credentialing departments to ensure full participation with contracted health plans.
• Maintain accurate plan participation status reports and billing information to maximize revenue cycle performance.

Skills

Effective communication

Microsoft Office

Education

Healthcare management degree

Job description

Who we are:

Peterson Health is an independent, not-for-profit rural community hospital located in Kerrville, TX- heart of the Texas Hill Country. Peterson was recently named one of the

Description

Who we are:

Peterson Health is an independent, not-for-profit rural community hospital located in Kerrville, TX- heart of the Texas Hill Country. Peterson was recently named one of the Top 20 rural and community hospitals in the country and the only one in Texas by the National Rural Health Association. Being named one of the Best Places to Work in Healthcare by Modern Healthcare for six consecutive years is a testament to Peterson's commitment to its team and to fulfilling its mission of providing exceptional, compassionate, patient-centered care.

Shift Information

This position is Full-Time

What We Offer

• Health Insurance
• 401(k)
• Dental Insurance
• Vision Insurance
• Paid time off
• Tuition Reimbursement | HPSA Designated
• Employee Education Scholarships
• Employee Referral Program
• Merit Increases
• Free access to a beautiful onsite fitness facility

What You Will Do

The Credentialing Coordinator is responsible for performing credentials verification for members of Peterson Regional Healthcare Network (PRHCN), and employed/contracted providers of Peterson Health to ensure compliance with standards set forth by the National Committee Quality Assurance (NCQA), Center for Medicare and Medicaid Services (CMS), Texas Medicaid & Healthcare Partnership (TMHP) and contracted payers. This position is responsible for submitting accurate and complete provider organizational and facilities providers enrollment applications, following up with payer credentialing departments and provider enrollment representatives to ensure providers are fully credentialed and loaded as participating with all applicable contracted health plans. The Credentialing Coordinator is accountable for maintaining and disseminating accurate plan participation status reports and billing information to all applicable PRHCN members to maximize collections in the revenue cycle management process.

Preferred Education

Associates or Bachelor’s degree in healthcare management

Required Skills

Effective communication skills to interact professionally with clinical and financial health care colleagues; intermediate knowledge of Microsoft Office

Preferred Skills

2+ years managing a provider credentialing system

Preferred Licensure /Registration /Certification

Certified Provider Credentialing Specialist as offered by the National Association of Medical Staff Services (NAMSS)

Preferred Experience

Minimum of 2 years experience in payer relations or credentialing with an insurance company, hospital, or other large group of providers.