USPI Credentialing Specialist (Remote)

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 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

Who We Are
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.
Our Story
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 Today
Today, we are leading health system and services platform that continues to evolve in lockstep with community need. Tenet's operations include three businesses - our hospitals and physicians, USPI and Conifer Health Solutions.
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. Apply