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TPR Credentialing Specialist (Hybrid- Dallas, TX)

Job ID: 2503002947-0 Date posted: 01/30/2025 Facility: Tenet Practice Resources

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Job Details

Description

Description

Candidate should possess extensive knowledge of Medicaid enrollment structure and process in multiple states, including familiarity with enrollment management systems to streamline operations.
Experience in group & individual Medicaid enrollment.
Knowledge of applicable state and federal laws, regulations and requirements related to Medicaid.
Proficiency in analyzing enrollment data to identify trends, ensure accuracy, and improve processes.
Ability to prepare and/or update a provider’s CAQH application, where applicable.
The ability to build and maintain peer-to-peer relationships with all internal and external business partners at all levels.
Establish credentialed statuses to facilitate billing.
Maintain and update credentialing, billing, and other internal databases completely and accurately which must include, but is not limited to, status updates, follow up timelines, and revenue risk associated with potential delays.
Ability to identify and communicate risk while maintaining and adhering to proper escalation procedures.
In-depth working knowledge of the various applications associated by plan as well as internally and the workflow process defined by department leadership.
Ensure all workflow items are completed within the set turn-around-times, meeting deadlines, while maintaining high levels of accuracy and quality.

2503002947

Qualifications

Qualifications

High School Diploma or equivalent required; completion of an applicable Vocational or Technical training program preferred.
Minimum of two years of experience in a credentialing role or related health care environment (such as credentialing or file maintenance) or heavy customer service background preferred.
Possess a comprehensive understanding of health plan credentialing processes, enrollment procedures, and related requirements to ensure compliance and operational efficiency.
Understanding of Medicaid enrollment (multiple states) as well as experience in navigating government portals required.
Demonstrate the ability to thrive in a fast-paced, deadline-intensive environment by efficiently managing multiple Medicaid enrollment processes.
Maintain a focus on overall success and the broader objectives of the team and organization.
Navigate setbacks with resilience and learn from mistakes without dwelling on them.
Ability to prioritize and multitask, with high attention to detail and organizational skills.
Ability to work independently in addition to contributing to a positive team environment and collective success.
Proven track record in cross-checking data and validating information to maintain high standards of accuracy and data integrity.
Strong problem-solving skills to address and resolve enrollment issues efficiently.
Excellent verbal and written communication skills.
Knowledge of Microsoft Word and other PC applications.
Strong Microsoft Excel skills (vlookups, pivot tables, etc.) is required.

Tenet Healthcare complies with federal, state, and/or local laws regarding mandatory vaccination of its workforce. If you are offered this position and must be vaccinated under any applicable law, you will be required to show proof of full vaccination or obtain an approval of a religious or medical exemption prior to your start date. If you receive an exemption from the vaccination requirement, you will be required to submit to regular testing in accordance with the law.

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Employment practices will not be influenced or affected by an applicant’s or employee’s 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.
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E-Verify: http://www.uscis.gov/e-verify