Texas Health Resources Delegation Credentialing Specialist in Dallas, Texas
Delegation Credentialing Specialist
We’re looking for a qualified Delegation Credentialing Specialist like you to join our Texas Health family.
Work location: Remote- Must live within DFW
Work environment: Office setting
Work hours: Full-time, 40 Hours Weekly, Flexible start and end time on Monday – Friday 8:00am – 5:00pm.
Bachelor's Degree (Preferred)
3 years of credentialing coordination experience in Healthcare (specifically, Physician Practice), managed care, and/or insurance management, etc. (Required)
CPCS - Certified Provider Credentialing Specialist Upon Hire (Preferred)
Experience with new installations and integrations of physician practices
Effective business acumen to develop positive relationships and strategies to perform effectively within the dynamics of a corporate organization
Incumbent must have extremely effective and polished communications skills - both written and oral
Ability to work independently and prioritize work, perform thorough investigation and follow through on issue resolution with minimal management intervention in a high pace environment
Proficient in the use of Outlook, Skype, Excel, Word, and PowerPoint, MD Staff Credentialing Database (or alternate credentialing software) with basic computer and keyboarding skills
Limits access to protected health information (PHI) to the information reasonably necessary to do the job and shares such information only on a need to know basis for work purposes. Handles confidential materials while using sound judgment.
Experience with developing policies and procedures to ensure compliance with applicable standards
Familiar with NCQA, URAC, and applicable state standards and how to apply them
Comfortable with health plan delegation audits and auditors; ability to maintain professionalism through adversity
Position Responsibilities- The Delegated Credentialing Specialist is primarily responsible for maintaining credentialing files of all network providers, in accordance with NCQA, URAC, and applicable state and health plan guidelines. Responsible for all aspects of the internal credentialing and recredentialing for THPG providers; to include ongoing monitoring, health plan audits, regulatory surveys.
Process delegated credentialing applications for both government/commercial health plan payers, and manage the ongoing participation requirements of the plans for all practitioners enrolled
Facilitate presentation of credentialing and recredentialing to the Credentialing Committee and any other applicable approving body/authority; completes all post-approval notifications, data entry, and system updates
Populate, maintain, and update the credentialing software to ensure accountability for the integrity of information enter into the system
Assist with coordination of audit activity for certifications (NCQA, URAC) and third party audits (payors, self-insureds, carriers, etc.) for both initial and concurrent audits for delegated credentialing services; also includes monitoring program compliance with contractual terms and effective enforcement of operational provisions
Validate the renewal of "Expirable" (e.g. board certifications, licenses, etc.) as needed 10%
Collaborate with Credentialing team to establish policies and procedures for credentialing and re-credentialing standards of THPG; Ensure accuracy of source documentation and system logs related to credentialing activities; Monitor compliance with state and federal regulations and accreditation standards.
Why Texas Health - As a THPG Employee you’ll enjoy top-notch benefits including 401(k) with match, paid time off, competitive health insurance choices, healthcare and dependent care spending account options, wellness programs to keep you and your family healthy, tuition reimbursement, a student loan repayment program and more.
At Texas Health, our people make this a great place to work every day. Our inclusive, supportive, people-first, excellence-driven culture make Texas Health Resources a great place to work.
Here are a few of our recent awards:
2021 FORTUNE Magazine’s “100 Best Companies to Work For®” (7th year in a row)
Becker's Healthcare "150 Great Places to Work in Healthcare" (4 years running)
“America’s Best Employers for Diversity” list by Forbes
A “100 Best Workplaces for Millennials" by Fortune and Great Place to Work®
Explore our Texas Health careers site for info like Benefits , Job Listings by Category , recent Awards we’ve won and more.
Do you still have questions or concerns? Feel free to email your questions to firstname.lastname@example.org
Employment opportunities are only reflective of wholly owned Texas Health Resources entities.
We are an Equal Opportunity Employer and do not discriminate against any employees or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class.