What are the responsibilities and job description for the TPR Credentialing Specialist (Hybrid- Dallas, TX) position at Tenet Practice Resources?
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.
