Credentialing Specialist (Remote based in US)

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 

 

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

• 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 …