Senior Credentialing Specialist, TPR

Deliverables include: Work closely with the local market onboarding team on all new providers in the pipeline. Requests all credentialing data and supporting documents from the physician. Communicates to market onboarding team when delays with the physician are in jeopardy of interrupting the defined project timelines. Candidates should have knowledge of NCQA standards, delegated credentialing, and Primary Source Verification. Prepare and/or update the provider’s CAQH application for newly affiliated and existing healthcare providers. Ability to build and maintain peer-to-peer relationships with all relevant market Health Plans. Strategically communicate newly affiliated providers to plan to initiate TIN change/demographic flip or initiate credentialing. Establish credentialed status to facilitate billing. Maintains credentialing databases and ensures up-to-date tracking of file process. Display in-depth knowledge of and execute all standard operating procedures (SOPs) as well as communicating issues, trends, and concerns to Regional Supervisor. In-depth working knowledge of the various applications associated with all plans and the workflow process. Identify any opportunity for process improvement and work with Regional Supervisor to challenge payors agendas. Ensure all workflow items are completed within the set turn‑around‑time, meeting quality expectations. Issue resolution relating to billing and collecting for services rendered. Educating internal markets on contractual obligations for each payor surrounding managing authorizations, billing requirements and operationalizing language to ensure that we are able to bill and collect for services rendered. Provide credentialing information to Market Operations to ensure that they have the information needed to effectively manage the practices from a credentialing perspective. Responsibilities Data Entry- 5% Initial credentialing or recredentialing per NCQA- 30% Health plan submission (delegated, non‑delegated)- 30% UCC credentialing- 25% Other duties as assigned- 10% Qualifications Qualifications: 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. Knowledge of health plan and governmental payer credentialing, enrollment, and requirements. Knowledge of CAQH application. Knowledge of contract language interpretation and administration Ability to work within a deadline‑intense environment. Demonstrated problem‑solving and customer service skills. Knowledge of Microsoft Word and other PC applications. High School Diploma required; completion of an applicable Vocational or Technical training program preferred. Excellent verbal and written communication skills. 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. 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. We have a rich history at Tenet. There are so many stories of compassionate care; so many "firsts" in terms of medical innovation; so many examples of enhancing healthcare delivery and shaping a business that is truly centered around patients and community need. Tenet and our predecessors have enabled us to touch many different elements of healthcare and make a difference in the lives of others. 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. 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. #J-18808-Ljbffr Socket.dev