Search Jobs

USPI Credentialing Specialist (Remote)

Job ID: 2503004403-0 Date posted: 02/17/2025 Facility: Other Staff

Apply Now

Job Details

Description

Description:

Tenet Healthcare has an immediate opening for a Credentialing Specialist to join our team remotely. 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, assisting 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, State Agency and Accreditation 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.

Required:

Superior organizational skills
Advanced analytical ability
Excellent communication
Collaborative work style
High School Diploma
Extensive knowledge of and past history working in PECOS

Preferred:

Prior experience with government payor processes
Strong knowledge of corporate structure
Some college

2503004403

Responsibilities

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.
Performs other duties as assigned.

Resulting Efficiencies:

Real-time visibility/status on all provider and facility payor credentialing files
All credentialing files completed in 90 days or less
Credentialing database leveraged to keep all credentialing files up to date – facilitating re-credentialing with payors

Qualifications

Qualifications

Communicates effectively with all internal and external clients, including managers, employees, vendors, support staff and visitors.
Uses good judgment and critical thinking skills; ability to identify and resolve problems.
Proficient in MS Office software; particularly Excel and Outlook
Preferred experience in a credentialing electronic database system, i.e. ECHO, Cactus, etc.
Possess a strong work ethic and a high level of professionalism with a commitment to client/patient satisfaction.
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.
2 years’ experience in healthcare required.
Experience with large national health plans such as United Healthcare, Cigna, or more is highly desirable
Knowledge of standards interpretation as related CAQH       
Ability to work within a deadline-intense environment.
Demonstrated problem-solving and customer service skills.

Compensation

Pay: $21.70-$34.70 per hour. Compensation depends on location, qualifications, and experience.
Position may be eligible for a signing bonus for qualified new hires, subject to employment status.
Observed holidays receive time and a half.

Benefits

The following benefits are available, subject to employment status:

Medical, dental, vision, disability, AD&D and life 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.

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.

#LI-SG2

Pay Range: $21.70 - $34.70 hourly **Individual wages are determined based upon a number of factors including, but not limited to, an individual’s qualifications and experience

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.
Tenet participates in the E-Verify program. Follow the link below for additional information.

E-Verify: http://www.uscis.gov/e-verify