Credentialing Coordinator jobs in Pflugerville, TX

Job Number : 24-12275

Job Summary : The Associate Credentialing Coordinator prioritizes and performs complex administrative and detailed credentialing work with minimal to no supervision including highly advanced customer service work that involves coordination with employees and external customers, credentialing and re-credentialing application review, primary source verification, data entry and databases management for accurate provider information, query and report preparation, research and dissemination, and Credentialing Committee meeting preparation.

This position is responsible for review, analysis, creation, tracking, maintaining, and updating provider credentialing electronic files and maintaining credentialing data base with accurate provider information and following up on discrepancies and other issues, as needed for internal and external providers.

Responsible for primary source verification and validation of documents for initial and an on-going basis to maintain internal and external providers license, certifications, insurance, and other time-related documents and required checks in a timely and accurate manner through verification including reminder notices.

Responsible for reviewing and processing external provider initial, renewal, and amendment contract requests for meeting credentialing and network requirements.

Responsible for completing provider enrollment including follow-up until enrolled via websites or communications with health plan representatives.

Ability to perform all aspects of position in a professional manner with tack and discretion maintaining confidentiality of provider information.

Must be able to understand, interpret, and adhere to credentialing procedures, state and national standards, and accreditation, such as NCQA and the Joint Commission.

Ability to update and / or develop procedures as needed to comply. Must be highly organized and perform work with attention to detail in a timely manner.

Ability to communicate with excellent verbal and written communication and interact effectively with all stakeholders and to respond timely to inquiries.

Ability to prioritize tasks and work independently. Comfortable working in a fast-paced credentialing environment

Regular, predictable attendance is an essential requirement for this position. Other duties may be assigned. May require a flexible work schedule.

Integral Care employees are to be committed to fostering an open, inclusive, and supportive environment that welcomes and embraces diversity in all forms.

Integral Care defines diversity broadly to include race, ethnicity, abilities (mental / physical), gender, gender identity, immigrant status, language, religion, sexual orientation, socioeconomic status, veteran status, age, and other groups.

Integral Care employees are to strive to maintain a trauma sensitive workplace, to embrace trauma sensitive and informed practices, and to foster a supportive and welcoming environment of care.

Education : Required :

Required :

Graduation from High School of GED equivalent.

Preferred :

Graduated from an accredited college or university with a Bachelor's degree with a major specialization in Human / Behavioral / Social Services or related field.

License / Certifications :

Required :

Certified Provider Credentialing Specialist (CPCS) or Certified Professional Medical Services Management (CPMSM) certification or the ability to obtain it in the future.

Experience : Required :

Required :

• Two years related experience in credentialing or healthcare background with knowledge of managed care and network development, provider relation activities or healthcare delivery system
• Working knowledge of instructional design concepts, including the ADDIE model, adult learning theory, and rapid curriculum development.
• Proficient in Microsoft Office Suite, including Word, PowerPoint, and Excel.

Preferred :

• Experience in credentialing software and databases, especially symplr Provider (formerly CACTUS).
• Experience with Council for Affordable Quality Healthcare (CAQH).
• Knowledge of National Commission on Quality Assurance (NCQA)
• Experience with Medicare and Medicaid and other health plan provider enrollment.
• Experience with state, federal, and accreditation entity regulations and requirements related to credentialing.

Hours : Full-Time.

Workdays : Monday-Friday.

Workhours : 8 : 00am-5 : 00pm.

Salary : $62,306 annually.

Why join us : Integral Care has proudly served Travis County residents for the past 50 years. As the largest provider of behavioral health services in Travis County, we are dedicated to improving the lives of adults and children living with mental illness, substance use disorder and intellectual and developmental disabilities.

By joining our team, you will find rewarding work every day alongside people who have as much compassion as you. Join us and together we can help improve the quality of life for the people we serve.

Imagine your career at Integral Care!

Employee Benefits :

Medical, Dental and Vision insurance

Generous vacation / holiday / sick leave

Life and Short-term / Long-term Disability Insurance

Employee Assistance Program (EAP)

403(b) retirement account

Gold's gym membership discount

Mileage reimbursement

Integral Care strives to maintain a diverse workforce. We encourage all to apply, including those who have knowledge and / or experience working with underserved populations, including Asian and Pacific Islander, Black / African American, Hispanic / Latino, and LGBTQA communities.

All qualified applicants will receive consideration for employment without regard to race, creed, color, religion, national origin, sexual orientation, gender identity, disability, veteran status, sex or age.

For specific positions, additional compensation may be available to those who are bilingual in both English and one of the following languages : Spanish, Chinese, Vietnamese, Korean, or Burmese.(PM16)

Last updated : 2024-06-05