In an effort toprovide a more healthy, safe and satisfying environment to our employees,individuals to whom job offers are extended may undergo nicotine testing as apart of the pre-employment process.
Tenet Healthcarehas an immediate opening for a Senior healthcare Provider EnrollmentCredentialing Specialist to join our team based in our downtown Dallasoffice. This is a full time job withbenefits, and parking or a DART pass is provided at no cost to our employees.
Work closely withthe local market onboarding team on all new providers in the pipeline.
â¢ Requests all credentialing data andsupporting documents from the physician. Communicates to market onboarding teamwhen delays with the physician are in jeopardy of interrupting the definedproject timelines.
â¢ Candidates should have knowledge of NCQAstandards, delegated credentialing and Primary Source Verification.
â¢ Prepare and/or update the providerâs CAQHapplication for newly affiliated and existing healthcare providers.
â¢ Ability to build and maintain peer-to-peerrelationships with all relevant market Health Plans. Strategically communicate newly affiliatedproviders to plan to initiate TIN change/demographic flip or initiate credentialing.
â¢ Establish credentialed status to facilitatebilling.
â¢ Maintains credentialing databases andensures up-to-date tracking of file process.
â¢ Display in-depth knowledge of and executeall standard operating procedures (SOPs) as well as communicating issues, trendsand concerns to Regional Supervisor.
â¢ In-depth working knowledge of the variousapplications associated with all plans and the workflow process. Identify anyopportunity for process improvement and work with Regional Supervisor tochallenge payors agendas.
â¢ Ensure all workflow items are completedwithin the set turn-around-time, meeting quality expectations.
â¢ Issue resolution relating to billing andcollecting for services rendered. Educating internal markets on contractual obligations for each payorsurrounding managing authorizations, billing requirements and operationalizinglanguage to ensure that we are able to bill and collect for services rendered.
â¢ Provide credentialing information to MarketOperations to ensure that they have the information needed to effectivelymanage the practices from a credentialing perspective.
â¢ Minimum of five years of experience in a managed care role, centralized credentialing office or related health care environment, such as credentialing or file maintenance.
â¢ Knowledge of health plan and governmental payer credentialing, enrollment and requirements.
â¢ Knowledge of CAQH application.
â¢ Knowledge of contract language interpretation and administration
â¢ Ability to work within a deadline-intense environment.
â¢ Demonstrated problem-solving and customer service skills.
â¢ Knowledge of Microsoft Word and other PC applications.
â¢ High School Diploma required; completion of an applicable Vocational or Technical training program preferred.
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 applicantâs or employeeâs 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.