Title: Senior Credentialing Coordinator

Employee Classification: Sr. Credentialing Coordinator

Campus: University of North Texas - Health Science Center

Division: HSC-Health Systems

SubDivision-Department: HSC-Health Systems & Clinical Aff

Department: HSC-HSC Health Administration-335001

Job Location: Fort Worth

Salary: commensurate with salary

FTE: 1.000000

Retirement Eligibility: TRS Eligible

About Us - Values Overview:

Department Summary

The Sr Credentialing Coordinator Specialist will maintain Provider and group files in billing system and on Payer websites. Troubleshoot enrollment related payer rejections and claim denials. Perform Managed Care enrollment with payer plans. Enrolls/Reactivates/Revalidates providers with Medicare/Medicaid/BCBS and Tricare. Ensures that provider enrollment applications are processed in a timely manner in order of the providers start date. Utilizes credentialing resources and other software as required.
Maintain credentialing databases by ensuring data is entered accurately and in timely manner. Analyze enrollment related payer denials and provide reporting and work with provider representatives to resolve discrepancies.

Position Overview

The Sr Credentialing Coordinator Specialist will maintain Provider and group files in billing system and on Payer websites. Troubleshoot enrollment related payer rejections and claim denials. Perform Managed Care enrollment with payer plans. Enrolls/Reactivates/Revalidates providers with Medicare/Medicaid/BCBS and Tricare. Ensures that provider enrollment applications are processed in a timely manner in order of the providers start date. Utilizes credentialing resources and other software as required.
Maintain credentialing databases by ensuring data is entered accurately and in timely manner. Analyze enrollment related payer denials and provide reporting and work with provider representatives to resolve discrepancies.

Minimum Qualifications

Bachelor's degree and three (3) year of related experience; or any equivalent combination of education and experience.

Knowledge, Skills and Abilities

Demonstrates expert skills and knowledge of the job; maintains and enhances skills and knowledge on a regular basis; stays up to date with current developments and trends in areas of expertise. Seeks opportunities to accept ideas; Not afraid to ask for help from leadership, when needed, to accomplish work goals; Ensures smooth transition of important information from one person or department to another; Participates actively and positively as part of a team to ensure the best outcome for the team, department, Customer and/or organization. Self-motivated and takes ownership on projects. Ability to work in high-stress environment. Maintains confidentiality of all documents.

Preferred Qualifications

Previous experience with provider credentialing processes, Payer enrollment processes and procedures. Prefer Certified Provider Credentialing Specialist (CPCS) certified.
Understanding of credentialing activities as they relate to initial credentialing, re-credentialing and credentials modification(s). Medicred Software Experience preferred.

Job Duties:

• Ensure compliance with applicable laws, regulations, procedures, and policies.
• Ensures that provider enrollment applications are processed in order of the providers start date. 
• Maintains database for applications and follow up as required with requests from departments, providers and outside agencies. 
• Process initial credentialing and re-credentialing applications.
• Screen practitioners’ applications and supporting documentation to ascertain their eligibility.
• Present applications to the facility’s Credentialing Committee.
• All other duties as assigned.

Physical Requirements:

• Communicating with others to exchange information.
• Repeating motions that may include the wrists, hands and/or fingers.

Environmental Hazards:

No adverse environmental conditions expected.

Work Schedule:

8-5 Monday through Friday/Hybrid-office/remote

Driving University Vehicle:

No

Security Sensitive:

This is a Security Sensitive Position.

Special Instructions:

Applicants must submit a minimum of two professional references as part of their application. If needed, additional references can be added after the application has been submitted. 

Benefits:

For information regarding our Benefits, click here.

EEO Statement:

The University of North Texas System is firmly committed to equal opportunity and does not permit -- and takes actions to prevent -- discrimination, harassment (including sexual violence, domestic violence, dating violence and stalking) and retaliation on the basis of race, color, religion, national origin, sex, sexual orientation, gender identity, age, disability, genetic information, or veteran status in its application, employment practices and facilities; nor permits race, color, national origin, religion, age, disability, veteran status, or sex discrimination and harassment in its admissions processes, and educational programs and activities, facilities and employment practices. The University of North Texas System promptly investigates complaints of discrimination, harassment and related retaliation and takes remedial action when appropriate. The University of North Texas System also takes actions to prevent retaliation against individuals who oppose any form of harassment or discriminatory practice, file a charge or report, or testify, assist or participate in an investigative proceeding or hearing.