Position Summary

The Credentialing Specialist for Tenet Physician Resources (TPR) is a key member of the Tenet Health credentialing team, responsible for managing the complete lifecycle of provider credentialing for TPR‑employed/contracted healthcare providers.

This role ensures the successful onboarding of high‑quality providers (physicians/mid-levels, etc., - multi-specialty/multi-state group) and supports the organization’s ability to bill and collect on day one of a provider’s start date.

The Credentialing Specialist is responsible for working closely with all relevant payors, maintaining current knowledge of payor credentialing and enrollment requirements, and upholding credentialing standards (NCQA/URAC/CMS/State Specific) to prevent delays during the onboarding process. Building and maintaining strong relationships with key payor partners is essential in this role.

Balancing the priorities of accurate credentialing and timely enrollment requires exceptional communication skills. The ideal candidate will effectively communicate any barriers internally affecting key milestones and proactively escalate unresolved issues. This role plays a critical part in ensuring compliance with regulatory requirements, safeguarding data integrity, and supporting TPR’s commitment to delivering high‑quality patient care.

Essential Duties & Responsibilities

• Manage the end‑to‑end credentialing process for TPR‑employed/contracted providers, including initial credentialing and recredentialing.
• Review and evaluate provider applications for accuracy, completeness, and compliance with TPR policies and regulatory standards.
• Conduct primary source verification of licensure, education, training, certifications, and references.
• Collaborate with providers, TPR practices, and internal departments to obtain required documentation and resolve credentialing discrepancies.
• Maintain up‑to‑date knowledge of payor credentialing/enrollment requirements and work directly with all applicable payors to ensure timely enrollments, communicate effective dates, update billing platforms and work with Revenue Cycle to resolve credentialing discrepancies.
• Build and manage strong relationships with key payor representatives to support efficient onboarding and issue resolution.
• Ensure ongoing compliance with accreditation standards, regulatory requirements, and internal credentialing policies.
• Maintain accurate, confidential provider files and credentialing databases.
• Monitor expirable items—such as licenses, board certifications, and malpractice insurance—to ensure timely renewals.
• Participate in audits, quality assurance activities, and process‑improvement initiatives.
• Identify and elevate risks or delays that may impact onboarding timelines or billing readiness.
• Assist in developing credentialing policies, procedures, and training programs.
• Provide support and guidance to junior credentialing staff, fostering a collaborative and high‑performing team environment.

Qualifications

• Bachelor’s degree in healthcare administration, business administration, or a related field highly desired; High School Diploma/GED (required) and equivalent experience considered.
• Minimum of 5 years of experience in healthcare provider credentialing, preferably within an equivalent field.
• Strong understanding of credentialing principles, regulatory requirements, and accreditation standards (e.g., NCQA, URAC).
• Experience performing primary source verification and reviewing provider applications for accuracy and compliance.
• Familiarity with credentialing software systems and databases.
• Ability to meet tight deadlines and manage multiple priorities in a fast‑paced environment.
• Excellent communication and interpersonal skills with the ability to interact effectively with internal stakeholders, providers, and external payor partners.
• Demonstrated ability to communicate project milestones, identify risks, and escalate issues appropriately.
• Strong attention to detail, organizational skills, and commitment to maintaining confidentiality.
• Analytical and strategic mindset with a focus on continuous improvement and process efficiency.
• Relationship‑driven approach with the ability to build and maintain strong partnerships with payor representatives.

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