Credentialing Specialist

Tenet Healthcare; Dallas (TX); On-site; USD 52,000 - 70,000; Full time

Job summary

Tenet Healthcare is seeking a credentialing professional to support provider enrollment and credentialing across plans, including Medicare and Medicaid. You will prepare CAQH applications, ensure timely credentialing, and build relationships with health plans.

Candidates should have knowledge of NCQA standards, CAQH, and the ability to travel up to 10% nationally to support multiple facilities and providers.

Qualifications

• Knowledge of NCQA standards and delegated credentialing (as per job summary).
• Experience with health plan credentialing and enrollment including Medicare and Medicaid.
• Ability to prepare/update CAQH applications for providers.

Responsibilities

• Knowledge of credentialing processes including primary source verification.
• Build and maintain relationships with health plans and market/national plans.
• Establish credentialed status to facilitate billing for multiple specialties.
• Maintain credentialing databases with accurate, up-to-date tracking.

Skills

Credentialing

CAQH

Excel

Communication

Travel

Education

High School Diploma

Vocational/Technical Training

Tools

MS Word

Job description

Overview

Who We Are

We are a community built on care. Our caregivers and supporting staff extend compassion to those in need, helping to improve the health and well-being of those we serve, and provide comfort and healing. Your community is our community.

Our Story

We started out as a small operation in California. In May 1969, we acquired four hospitals, some additional care facilities and real estate for the future development of hospitals. Over the years, we've grown tremendously in size, scope and capability, building a home in new markets over time, and curating those homes to provide a compassionate environment for those entrusting us with their care.

Our Impact Today

Today, we are leading health system and services platform that continues to evolve in lockstep with community need. Tenet's operations include three businesses - our hospitals and physicians, USPI and Conifer Health Solutions.

Our impact spreads far and deep with 65 hospitals and approximately 510 outpatient centers and additional sites of care. We are differentiated by our top notch medical specialists and service lines that are tailored within each community we serve. The work Conifer is doing will help provide the foundation for better health for clients across the country, through the delivery of healthcare-focused revenue cycle management and value-based care solutions.

Together as an enterprise, we work to save lives and can accept nothing less than excellence from ourselves in service of our patients and their families, every day.

Job Summary

Summary:

• Candidates should have knowledge of NCQA standards, delegated credentialing, and Primary Source Verification.
• Candidates should have knowledge of health plan credentialing and enrollment including Medicare and Medicaid.
• Ability to prepare and/or update the provider’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

Qualifications

Qualifications:

• High School Diploma or equivalent required; completion of an applicable Vocational or Technical training program preferred.
• Minimum of two years of experience in a credentialing role or related health care environment (such as credentialing or file maintenance) or heavy customer service background preferred.
• Strong Microsoft Excel skills (vlookups, pivot tables, etc.) is required.
• Must have the ability to travel up to 10% nationally.
• 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.
• Excellent verbal and written communication skills.

#LI-SG1

Organization Description

Careers at Tenet

At Tenet Healthcare, the heart of what we do centers on caring with compassion, which ultimately creates a bond between our caregivers and patients. Everyone contributes to these moments, whether providing care directly or supporting those who do.

As an organization, we provide employees with resources, tools and support to serve our patients and customers in the best way possible. We also take care of one another, helping team members further develop their career pathways and maximize their potential.

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.
Tenet participates in the E-Verify program. Follow the link below for additional information.
E-Verify: http://www.uscis.gov/e-verify
The employment practices of Tenet Healthcare and its companies comply with all applicable laws and regulations.