Essential Duties and Responsibilities
Ensure accurate and timely completion, submission, and follow-up on all outstanding credentialing/re-credentialing applications with payers and hospitals.
Collect primary source verification documentation for initial credentialing, including licensing, board certifications, proof of professional liability insurance, and other necessary documents.
Establish and maintain positive working relationships with payer representatives, hospital medical staff, internal departments, and providers.
Maintain credentialing database and ensure information is up to date at all times.
Notify staff upon completion of provider credentialing and plan participation status for scheduling and billing purposes.
Prepare and maintain Texas Standardized Credentialing Application (TSCA), CAQH, and Availity for all providers.
Complete NPPES (NPI), PECOS (CMS) and Texas Medicaid applications
Verify that all credentialing requirements are met.
Work with the billing department to resolve provider enrollment issues resulting in claim rejections/denials.
Responsible for monthly submission of provider roster to health plans and timely communication of group additions, changes, and terminations.
Stay abreast of regulatory requirements.
Track continuing education credits for all providers.
Adhere to HIPAA privacy regulations.
Perform other duties as assigned.
KEY COMPETENCIES
Recent credentialing experience
Experience in both group and individual provider credentialing.
Experience in credentialing of major payers such as Medicare, Medicaid, Tricare, BCBS, Aetna, Cigna, Humana, and other commercial and managed plans.
Knowledge of state and payer specific guidelines.
Experience in creating CAQH, NPI, and PECOS profiles and applications.
Detail oriented and capable of exploring innovative solutions to solve complex problems.
Ability to work independently and maintain a positive attitude.
Ability to manage multiple and simultaneous responsibilities.
Ability to maintain confidentiality of all medical, financial, and legal information.
Ability to complete work assignments accurately and in a timely manner.
Ability to communicate effectively, with excellent verbal and written communication and customer relation skills.
Strong organizational skills
QUALIFICATIONS
Minimum of two (2) years’ credentialing experience with a large provider practice or hospital system
Proficiency with computer systems and Microsoft Office (Word & Excel) required.
PHYSICAL DEMANDS
Requires sitting and standing associated with a normal office environment.
WORK ENVIRONMENT
Primarily clinic or office setting.
Benefits
401(k)
AD&D insurance
Dental insurance
Disability insurance
Flexible spending account
Free parking
Health insurance
Life insurance
Paid time off
Vision insurance
Experience
Credentialing: 2 years (Required)
Microsoft Word: 1 year (Required)
Work Location: In person
