What are the responsibilities and job description for the TPR Credentialing Specialist (Hybrid based in Dallas, TX) position at Tenet Practice Resources?
Summary:
- Candidates should have knowledge of NCQA standards, delegated credentialing, and Primary Source Verification.
- Candidates should have knowledge of health plan credentialing and enrollment including Medicare and Medicaid.
- Ability to prepare and/or update the provider’s CAQH application for newly affiliated and existing healthcare providers for initial and recredentialing activity.
- The ability to build and maintain peer-to-peer relationships with all relevant market and national health plans.
- Establish credentialed status to facilitate billing for multiple specialties.
- Maintain and update credentialing databases completely and accurately and ensures up-to-date tracking of file process.
- 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 quality expectations.
- Roster management and reporting experience preferred
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