Senior Credentialing and Managed Care Coordinator

1 week ago

Irving, Texas, United States Texas Oncology Full time
About Texas Oncology

We are a leading community oncology provider, delivering high-quality, evidence-based care to patients close to home. Our mission is to make 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.

About the Role

The Credentialing and Managed Care Coordinator will play a critical role in supporting our corporate location in Dallas, Texas. The ideal candidate will have a strong background in credentialing and managed care, with a minimum of 5 years of experience in a related field.

Key Responsibilities
  • Coordinate provider credentialing, licensure, and hospital privileges activities, ensuring compliance with quality standards and company policies.
  • Assist with administrative activities to support state/practice managed care functions, including provider plan participation and credentialing, contract files, and managed care reporting.
  • Support and adhere to the US Oncology Compliance Program, including the Code of Ethics and Business Standards and Shared Values.
Essential Duties and Responsibilities
  • Credentials and re-credentials providers according to quality standards and company policies and procedures.
  • Maintains current provider licensure files and provides information to hospitals and other healthcare providers as appropriate.
  • 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.
Qualifications
  • High School diploma or equivalent required.
  • Technical certification or Associate's Degree a plus.
  • At least 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.
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.

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