Payer Credentialing Specialist, Revenue Cycle, UT Health Austin

Job Posting Title:

Payer Credentialing Specialist, Revenue Cycle, UT Health Austin

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Hiring Department:

Dell Medical School

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Position Open To:

All Applicants

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Weekly Scheduled Hours:

40

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FLSA Status:

Non-Exempt

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Earliest Start Date:

Jan 31, 2025

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Position Duration:

Expected to Continue

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Location:

AUSTIN, TX

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Job Details:

Purpose

The Payer Enrollment Specialist is responsible for managing the enrollment process for healthcare providers within the clinics. This role involves coordinating with various insurance payers, ensuring accurate documentation, and maintaining compliance with regulatory requirements to facilitate seamless provider participation in insurance networks. The Payer Enrollment Specialist plays a crucial role in optimizing revenue cycles and enhancing patient access to care.

Responsibilities

• Assemble and submit credentialing application packets, maintaining practitioner files and ensuring confidentiality of all documents.

• Enroll and maintain providers in Medicare, Medicaid, Commercial, and Managed Care payers, including managing NPI applications.

• Collaborate with the Medical Staff Office to ensure current credentialing documents (e.g., CVs, licenses) are maintained.

• Follow up on pending applications, enter data into CAQH profiles, and ensure quarterly re-attestation.

• Build relationships with provider representatives and communicate
  application statuses to clinic and Revenue Cycle staff.

• Provide reports to payers as per credentialing agreements and address credentialing-related inquiries across departments.

• Coordinate with Revenue Cycle staff on claims denials and participate in payer audits as needed.

• Perform other duties as assigned.

Required Qualifications

High school diploma, GED, and seven (7) years of related clinical or healthcare experience or Bachelor’s degree and three (3) years of experience in payer enrollment or credentialing. Proficient in working with CMS Identity & Access Management (I&A), PECOS (Provider Enrollment, Chain, and Ownership System), and CAQH (Council for Affordable Quality Healthcare). Strong ability to understand and follow directions, while developing and tracking implementation plans. Effective verbal and written communication skills with payers, providers, and clinical operations teams. Ability to establish and maintain effective working relationships with all individuals. Commitment to maintaining the confidentiality of provider information. Proficient in using computers, with a working knowledge of Microsoft Office, especially Excel and PDF. Capable of functioning in a fast-paced environment and adapting to changing assignments while multitasking. Demonstrated problem-solving skills related to billing and credentialing issues.

Relevant education and experience may be substituted as appropriate.

Preferred Qualifications

Previous experience working with a credentialing software.

Salary Range

$50,000+ depending on qualifications

Working Conditions

• May work around standard office conditions

• Repetitive use of a keyboard at a workstation

• Use of manual dexterity

Required Materials

• Resume/CV

• 3 work references with their contact information; at least one reference should be from a supervisor

• Letter of interest

Important for applicants who are NOT current university employees or contingent workers: You will be prompted to submit your resume the first time you apply, then you will be provided an option to upload a new Resume for subsequent applications. Any additional Required Materials (letter of interest, references, etc.) will be uploaded in the Application Questions section; you will be able to multi-select additional files. Before submitting your online job application, ensure that ALL Required Materials have been uploaded.  Once your job application has been submitted, you cannot make changes.

Important for Current university employees and contingent workers: As a current university employee or contingent worker, you MUST apply within Workday by searching for Find UT Jobs. If you are a current University employee, log-in to Workday, navigate to your Worker Profile, click the Career link in the left hand navigation menu and then update the sections in your Professional Profile before you apply. This information will be pulled in to your application. The appl