Credentialing Specialist - THPG

Job description 26005202 Credentialing Specialist

• THPG Bring your passion to Texas Health so we are Better + Together Position Highlights Work location: REMOTE/ Work from Home
• Dallas Work Location Must live within DFW Work environment: Office Work hours: Full-time, 40 hours weekly, Monday thru Friday, 8:00am
• 5:00 pm

Facility:

Texas Health Physicians Group (THPG)

Address:

Texas Health Physicians Group 612 E. Lamar

TX 76011

Texas Health Physicians Group (THPG) is a not-for-profit physician organization with more than 250 locations and 800 physicians, nurse practitioners and physician assistants dedicated to providing quality care in clinics and medical offices throughout North Texas. What You Will Do Independently manages end to end credentialing and recredentialing for physicians and advanced practice providers across managed care settings 25%Coordinate, monitor, and prepare documentation for all practitioners both inpatient and/or outpatient services in all applicable health care settings 15% Oversees delegated credentialing processes for commercial and government payers, ensuring adherence to NCQA and contractual requirements 10% Prepares, submits, and maintains Medicare and Medicaid enrollment and revalidation applications, ensuring accuracy and regulatory compliance 10% Coordinates and supports Credentialing Committee review, including agenda preparation, provider presentation, post approval communication, and system updates 10% Serves as a primary liaison for internal leadership, providers, and external payers regarding credentialing status, compliance requirements, and issue resolution 5% Leads preparation for and participation in NCQA, URAC, and third party audits, including initial, delegated, and re certification audits 5% Monitors and validates all expirable credentials, licenses, and certifications; proactively mitigates compliance risks. 10% Develops, analyzes, and reports credentialing metrics to leadership, including enrollment status, turnaround times, and provider responsiveness 5% Participates in process improvement initiatives to enhance credentialing efficiency, compliance, and provider experience 5% What You Need Education Bachelor's Degree Pref And H.S. Diploma or Equivalent Req Experience 3 Years 3-5+ years of progressive experience in provider credentialing and enrollment required Req 3 Years Demonstrated experience with delegated credentialing and accreditation audits. Req Licenses and Certifications CPCS

• Certified Provider Credentialing Specialist Upon Hire Pref Skills Advanced knowledge of provider credentialing, recredentialing, and delegated credentialing processes across hospitals, physician practices, and managed care environments Strong working knowledge of regulatory and accreditation standards, including NCQA, URAC, CMS, Joint Commission (TJC), and state/federal requirements, and the ability to apply standards operationally Demonstrated expertise in Medicare and Medicaid provider enrollment and revalidation, including PECOS requirements and payer participation rules High level of proficiency in credentialing and enrollment systems (e.

g., MD Staff, CredentialStream, CAQH, PECOS, and alternate credentialing software), with strong attention to data accuracy and integrity Exceptional analytical and problem solving skills, with the ability to independently investigate discrepancies, resolve complex credentialing issues, and mitigate compliance risk Highly developed verbal and written communication skills, with the ability to communicate credentialing requirements, deficiencies, and status updates effectively to providers, leadership, payers, and external stakeholders Ability to manage multiple concurrent credentialing and enrollment workflows, prioritize competing deadlines, and meet regulatory turnaround requirements in a fast paced environment Demonstrated professionalism, discretion, and ability to handle confidential and sensitive provider information in accordance with HIPAA and organizational standards Strong organizational skills with the ability to maintain accurate records, reports, and credentialing metrics for leadership review and operational decision making Capacity to work both independently and collaboratively, providing functional guidance, workflow support, and subject matter expertise to peers as needed Proficient in Microsoft Office applications (Outlook, Excel, Word, PowerPoint), including the ability to track data, generate reports, and support credentialing analytics Supervision Individual Contributor ADA Requirements Working Indoors 67% or more Physical Demands Sedentary Keywords credentialing-profiling telecommuting-and-remote-workers environment-health-and-safety-hsse ecology-environment hours-of-work time-and-attendance clubs-organizations medical-facilities-services policies-and-practices managed-care health-care compliance regulatory-compliance presentations audits training-certification financial-turnaround process-improvement education-training charger-management-software-cms card-management centers-for-medicare-and-medicaid-services-cms cms-tools content-management-system-cms commissions state-local-municipal pecos mdstaff credentialstream health-information-privacy-hipaa hipaa-compliance workflow domain-expertise microsoft-outlook microsoft-excel microsoft-powerpoint analytics data-analytics american-diabetes-association-ada disabilities-ada