Credentialing Coordinator

Job Description

The Center for Cancer and Blood Disorders provides cancer treatment to patients throughout North Texas. We are seeking a Full-time Credentialing Coordinator for our Fort Worth office.

Essential Duties And Responsibilities

• Ensure accurate and timely completion, submission, and follow-up on all outstanding credentialing/re-credentialing applications with payers and hospitals.
• Collect primary source verification documentation for initial credentialing, including licensing, board certifications, proof of professional liability insurance, and other necessary documents.
• Maintain positive working relationships with payer representatives, hospital medical staff, internal departments, and providers.
• Maintain credentialing database and ensure information is up to date at all times.
• Notify staff upon completion of provider credentialing and plan participation status for scheduling and billing purposes.
• Prepare and maintain Texas Standardized Credentialing Application (TSCA), CAQH, and Availity for all providers.
• Complete NPPES (NPI), PECOS (CMS) and Texas Medicaid applications.
• Verify that all credentialing requirements are met.
• Work with the billing department to resolve provider enrollment issues resulting in claim rejections/denials.
• Responsible for monthly submission of provider roster to health plans and timely communication of group additions, changes, and terminations.
• Stay abreast of regulatory requirements.
• Track continuing education credits for all providers.
• Adhere to HIPAA privacy regulations.
• Perform other duties as assigned.

Key Competencies

• Recent credentialing experience
• Experience in both group and individual provider credentialing
• Experience in credentialing of major payers such as Medicare, Medicaid, Tricare, BCBS, Aetna, Cigna, Humana, and other commercial and managed plans
• Knowledge of state and payer specific guidelines
• Experience in creating CAQH, NPI, and PECOS profiles and applications
• Detail oriented and capable of exploring innovative solutions to solve complex problems
• Ability to work independently and maintain a positive attitude
• Ability to manage multiple and simultaneous responsibilities
• Ability to maintain confidentiality of all medical, financial, and legal information
• Ability to complete work assignments accurately and in a timely manner
• Ability to communicate effectively, with excellent verbal and written communication and customer relation skills
• Strong organizational skills

Qualifications

• Minimum of two (2) years’ credentialing experience with a large provider practice or hospital system
• Proficiency with computer systems and Microsoft Office (Word & Excel)