Credentialing Specialist - ProCare

Job Details

Job Location

Cantex Continuing Care Network LLC - Carrollton, TX

Job Description :

The Credentialing Specialist is responsible for oversight of all credentialing and enrollment across our enterprise. This employee will work directly with our Contracting team to ensure all documents are up to date and are in compliance according to the State of Texas.

Preferred Qualifications :

MUST HAVE : Credentialing Experience

College degree or equivalent work experience (2-5 years)

2+ years of experience in credentialing and enrollment

Demonstrated excellent oral, written, interpersonal, analytical, and negotiation skills

Ability to use PC software and multiple systems

Ability to work autonomously

Ability to travel required (20-50%)

PREFERRED LOCATION : Dallas TX

Essential Duties and Responsibilities :

Create and Maintain Licensing

Conduct research on state and federal regulations and policies

Monitor licensing and credential expiration dates

Develop and maintain department's policies & procedures (P&P)

Review initial and reappointment credentialing efforts

Complete the credentialing process for new contract requests

Provide continuous reporting on new hire credentialing statuses, initial enrollments, etc

Communicate with payors to validate and verify participation status and the requirements to enroll providers

Enroll new providers / agencies / facilities with each contracted payor by completing payor specific enrollment applications within set internal time frames

Maintain re-credentialing and revalidation statuses for existing providers for government and commercial payors

Maintain Provider Directory Validation requests from applicable payors on a quarterly basis

Follow up with payors on submitted applications and to obtain individual provider effective dates when application is approved

Update provider's CAQH, TMHP, and PECOS per health plan requirements

Research and document enrollment processes such as initial enrollment, recredit, and demographic changes for each payor in every participating state

Collect and file required enrollment documentation from provider and health plans onto the shared drive and data platform when necessary

Create workflows by capturing requests such as : initial enrollment, re-credentialing, revalidations and demographics changes.

Responsible for entering final status from health plan such as : denials, approvals, effective dates, and PINS

Communicate with payors and contracting staff in a professional and timely manner

Diversity, Equity, and Inclusion are at the heart of Cantex. We are committed to a culture that respects our differences and values the contributions of all people.

Please visitcantexcc.comfor more information about our organization.

We are an Equal opportunity employer; We offer an excellent benefit plan to include 401K with match, CEU reimbursement, vacation, sick, holidays, medical, dental, and supplemental insurance Plans as well as a Highly competitive compensation package.