Humana Tricare Jobs (NOW HIRING)

The Center for Cancer and Blood Disorders provides cancer treatment to patients throughout N. Texas. We are looking for talented and highly motivated individuals to support the meaningful work of caring for cancer patients. We provide opportunities for professional growth and development. Our employees are our greatest asset! Come join our team! We are seeking a Full-time Credentialing Coordinator for our Fort Worth office.

Scope:

The Credentialing Coordinator will report to the Contracting Manager. The Credentialing Coordinator is responsible for all aspects of the credentialing and recredentialing of health care professionals, including payer enrollment, hospital privileging and licensing. The coordinator will process payor and hospital applications in accordance with medical staff and payor procedures. The coordinator will work collaboratively with other internal departments to troubleshoot out of network payer issues and other payer-related enrollment discrepancies. Work includes accurate, timely and documented verification of information and maintenance of provider credentialing files.

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.
• Establish and 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) required.

PHYSICAL DEMANDS:

Requires sitting and standing associated with a normal office environment.

WORK ENVIRONMENT:

Primarily clinic or office setting.

Benefits:

401(k)AD&D insuranceDental insuranceDisability insuranceFlexible spending accountFree parkingHealth insuranceLife insurancePaid time offVision insurance

Experience:

Credentialing: 2 years (Required)Microsoft Word: 1 year (Required)Work Location: In person