Hospital Credentialing Specialist (Remote based in US)

Tenet Healthcare-posted 12 months ago
$26 - $34/Yr
Remote • Dallas, TX
5,001-10,000 employees
Hospitals
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Tenet Healthcare has an immediate opening for a remote Credentialing Specialist to join our team. This position is responsible for maintaining enrollment of Tenet's and USPI's facilities in Medicare and Medicaid programs, assuring accurate information is on file with these agencies and state licensing authorities. This individual will assist facilities with state licensure matters and otherwise supporting the company's ability to receive payments from government programs.

  • File initial and revalidation applications with Center for Medicare and Medicaid Services and in state Medicaid.
  • Update Medicare and Medicaid upon change of information and change of ownership.
  • Assist with out of state Medicaid filings as requested.
  • Assist with licensure process (hospital, pharmacy, CLIA, DEA, etc.) as requested.
  • Processes provider applications and re-applications; including the initial mailing, review and loading.
  • Processes credentialing and re-credentialing applications of health care providers and assist in the implementation of related procedures and activities.
  • Reviews applications, prepares verification letters, and maintains database and provider profiling system.
  • Communicates with providers, medical office staff, licensing agencies, and insurance carriers to provide status information and complete credentialing and re-credentialing applications.
  • In-depth working knowledge of the various payor applications associated and the workflow process.
  • Ensure all workflow items are completed within the set turn-around-time, meeting quality expectations.
  • Responds to escalated issues by resolving or redirecting internally.
  • Maintain sam.gov registrations.
  • Performs other duties as assigned.
  • High School Diploma or equivalent is required.
  • 2 years of healthcare experience is required.
  • Recent credentialing/medical services or closely related experience.
  • Superior organizational skills.
  • Excellent communication.
  • Collaborative work style.
  • Prior experience with government payor processes.
  • Experience with the use of credentialing software, like ECHO or Cactus, strongly preferred.
  • Knowledge of standards interpretation as related CAQH.
  • Functional knowledge of NCQA Standards in Credentialing.
  • Functional knowledge of Provider Enrollment processes.
  • Functional knowledge of HIPAA rules and regulations and experience related to privacy laws, access and release of information.
  • Some college.
  • Medical, dental, vision, disability, life, AD&D and business travel insurance.
  • Paid time off (vacation & sick leave).
  • Discretionary 401k with up to 6% employer match.
  • 10 paid holidays per year.
  • Health savings accounts, healthcare & dependent flexible spending accounts.
  • Employee Assistance program, Employee discount program.
  • Voluntary benefits include pet insurance, legal insurance, accident and critical illness insurance, long term care, elder & childcare, auto & home insurance.
  • For Colorado employees, paid leave in accordance with Colorado's Healthy Families and Workplaces Act is available.
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