Senior Credentialing and Managed Care Coordinator

3 months ago

Dallas, United States Texas Oncology Full time

Overview: The US Oncology Network is looking for a Credentialing and Managed Care Coordinator to join our team at Texas Oncology This position will support our corporate location in Dallas, Texas.As a part of The US Oncology Network, Texas Oncology delivers high-quality, evidence-based care to patients close to home. Texas Oncology is the largest community oncology provider in the country and has approximately 600+ providers in 280+ sites across Texas, our founders pioneered community-based cancer care because they believed in making the best available cancer care accessible to all communities, allowing people to fight cancer at home with the critical support of family and friends nearby. Our mission is still the same today-at Texas Oncology, we use leading-edge technology and research to deliver high-quality, evidence-based cancer care to help our patients achieve "More breakthroughs. More victories." ® in their fight against cancer. Today, Texas Oncology treats half of all Texans diagnosed with cancer on an annual basis. The US Oncology Network is one of the nation's largest networks of community-based oncology physicians dedicated to advancing cancer care in America. The US Oncology Network is supported by McKesson Corporation focused on empowering a vibrant and sustainable community patient care delivery system to advance the science, technology, and quality of care. What does the Credentialing and Managed Care Coordinator do? (including but not limited to) Under minimal supervision, applies credentialing knowledge to efficiently coordinate provider credentialing licensure and hospital privileges activities. Assists in administrative activities to support state/practice managed care functions, which may include provider plan participation and credentialing, contract files, EOB analysis and managed care reporting. Supports and adheres to the US Oncology Compliance Program to include the Code of Ethics and Business Standards and Shared Values. Responsibilities: The essential duties and responsibilities (including but not limited to) Credentials and re-credentials providers according to quality standards and company policies and procedures. Notifies providers of licensure expirations and submits licensure applications and renewal forms with payment to State agencies and appropriate departments. Recommends process improvements. Maintains current provider licensure files and provides information to hospitals and other healthcare providers as appropriate. Requests and completes hospital credentialing and privileges applications for providers. Obtains and maintains provider participation in managed care plans in a timely manner and communicates information to practice sites and business office. May implement and maintain the contract management system to include terms of the contract, providers credentialed to the payer and other contracted service providers (labs, hospitals). May complete EOB analyses or fee schedule variance reporting on a monthly basis for the top Managed Care payers according to policy and procedure. May produce monthly managed care reports and implement new analysis tools to assist in reporting functions. May maintain expected reimbursement by CPT code for the top payer contracts in each market and communicate changes to system librarian. May develop and provide maintenance of proformas for all contracts. Supports Network Contracting Representative/Manager in general administrative functions. Trains junior and practice staff with respect to credentialing contracts, policies and procedures. Other duties as requested or assigned. Qualifications: The ideal candidate for this role will have the following background and experience: High School diploma or equivalent required. Technical certification or Associate's Degree a plus. At least five (5) years of credentialing related work experience required. Proficiency with computer systems and Microsoft (Office Outlook, Word, Power Point, and Excel) required. Competencies: Uses Technical and Functional Experience: Possesses up to date knowledge of the profession and industry; is regarded as an expert in the technical/functional area; accesses and uses other expert resources when appropriate. Demonstrates Adaptability: Handles day to day work challenges confidently; is willing and able to adjust to multiple demands, shifting priorities, ambiguity and rapid change; shows resilience in the face of constraints, frustrations, or adversity; demonstrates flexibility. Uses Sound Judgment: Makes timely, cost effective and sound decisions; makes decisions under conditions of uncertainty. Shows Work Commitment: Sets high standards of performance; pursues aggressive goals and works efficiently to achieve them. Commits to Quality: Emphasizes the need to deliver quality products and/or services; defines standards for quality and evaluated products, processes, and service against those standards; manages quality; improves efficiencies. Physical Demands: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is required to be present at the employee site during regularly scheduled business hours and regularly required to sit or stand and talk or hear. Requires full range of body motion including handling and lifting patients, manual and finger dexterity, and eye-hand coordination. Requires standing and walking for extensive periods of time. Occasionally lifts and carries items weighing up to 40 lbs. Requires corrected vision and hearing to normal range. Work Environment: The work environment may include exposure to communicable diseases, toxic substances, ionizing radiation, medical preparations and other conditions common to an oncology/hematology clinic environment. Work will involve in-person interaction with co-workers and management and/or clients. Work may require minimal travel by automobile to office sites.

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