Credentialing Specialist (Quality and Audit)

Credentialing Specialist – Quality Assurance & Data Coordinator TPR

 

POSITION SUMMARY

This position will work in conjunction with all internal stakeholders to provide guidance, training and compliance monitoring for all areas of the TPR Credentialing Team.  The Coordinator will work to oversee the data systems to ensure accuracy, continuous quality improvement and regular leadership reporting. This position will also be responsible for supporting the delegation team with health plan and internal audits, KPI report cards, Job Aids, Process Definition and Quality Improvement Plans.

 

ESSENTIAL DUTIES AND RESPONSIBILITIES

• Ability to gather, analyze and utilize data efficiently and effectively. 
• Knowledge of health plan credentialing and enrollment including NCQA standards, delegated credentialing timelines and regulatory and Medicare and Medicaid.
• Ensure all workflow items are completed within the set turn-around-times, meeting quality expectations
• Effectively communicates data driven team results and program insights.  Additionally coordinates with management to ensure all areas of improvement are addressed and escalated as necessary
• The ability to build and maintain peer-to-peer relationships with all relevant market and internal stakeholders. 

 

EDUCATION / EXPERIENCE

• Minimum of two years of experience in a credentialing role or related health care environment, such as credentialing or file maintenance, physician office or medical assistant preferred 
• High School Diploma or equivalent required; completion of an applicable Vocational or Technical training program preferred.
• Excellent verbal and written communication skills
• Excellent attention to detail

 

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.  

Include the following. Others may be assigned.

No. Description % of Time

1.  

Completes all initial credentialing per policies and procedures. 80%

1.  

Prepares newly credentialed providers for monthly committee meeting. 5%

1.  

Assists in answering provider calls. 15% FINANCIAL RESPONSIBILITY (Specify Revenue/Budget/Expense):  N/A SUPERVISORY RESPONSIBILITIES 

If direct report positions are listed below, the following responsibilities will be performed in accordance with guidelines, policies and procedures and applicable laws. Supervisory responsibilities include interviewing, hiring, and training employees; planning, assigning and directing work; appraising performance; rewarding and disciplining employees; addressing complaints and resolving problems. 

Direct Reports (titles) N/A Indirect Reports (titles) N/A

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

•  Strong communication and interpersonal skills.
• Excellent organizational and management skills.
• Attention to detail
• Knowledge of NCQA/state/federal standards.
• Proficient in Database, MS Excel, Word and other software  systems. 
• A team player with multi-tasking capability and strong customer service orientation.

Conifer requires its candidates, as applicable and as permitted by law, to obtain and provide confirmation of all required vaccinations and screenings prior to the start of employment.  This may include, but is not limited to, the COVID-19 vaccination, influenza vaccination, and/or any future required vaccines and screenings.

 

EDUCATION / EXPERIENCE

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