Credentialing Coordinator

1 week ago


Dallas, Texas, United States Children's Health (Dallas) Full time

Unlock Your Potential as a Credentialing Coordinator

We are seeking a highly skilled and detail-oriented Credentialing Coordinator to join our team at Children's Health in Dallas, Texas. As a key member of our credentialing team, you will play a vital role in ensuring the smooth processing of provider credentials for government plans, Medicaid Managed Care plans, and commercial plans.

About the Role:

The successful candidate will be responsible for preparing credentialing files for individual and organizational providers, performing primary source verification, and maintaining accurate demographic information and required licensure/certification documentation. You will also manage the enrollment process for government plans, Medicaid Managed Care plans, and commercial plans, coordinating with practitioners or their representatives to gather and verify necessary data.

Your Key Responsibilities Will Include:

  • Credentialing File Preparation: Prepare comprehensive credentialing files for individual and organizational providers, adhering to NCQA, CMS, TMHP, and contracted payer standards.
  • Primary Source Verification: Perform thorough primary source verification using pre-approved sources, documenting verification efforts consistently with Children's Health Provider Credentialing policies.
  • Demographic Information Maintenance: Obtain, verify, and maintain complete and accurate demographic information and required licensure/certification documentation for supported individual practitioners and organizational providers.
  • Enrollment Process Management: Manage the enrollment process for government plans, Medicaid Managed Care plans, and commercial plans, collaborating with multiple departments to obtain and retain current copies of certificates and other documents.

Requirements:

To succeed in this role, you will need:

  • At least 2 years' experience in Payor Relations or Credentialing with an insurance company, hospital, or other large group of providers;
  • A two-year associate's degree or equivalent experience; and
  • Certification as a Certified Provider Credentialing Specialist (CPCS) is preferred.

What We Offer:

As a valued member of our team, you can expect a competitive salary range of $65,000 - $85,000 per year, depending on your level of experience and qualifications. Our benefits package includes wellness and fitness programs, medical benefits, dental benefits, vision benefits, holiday pay, pet insurance, employee assistance programs, license and certification reimbursement, and life insurance.

About Us:

Children's Health is a leading pediatric healthcare organization dedicated to making life better for children. We strive to deliver exceptional patient and family experiences, promoting children's health and well-being through cutting-edge treatments and partnerships with top healthcare institutions like UT Southwestern. Join our mission to create a brighter future for children and contribute to a healthier community.



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