Credentialing Manager - IntraCare - Carrollton, TX

Company Summary

IntraCare Health Center (DFW Healthcare MSO) provides services to multiple healthcare organizations in the greater Dallas-Ft. Worth area. Led by an exceptional leadership team, the company has delivered a decade of solid performance and service excellence in value-based care, clinic operations, and lab services.

IntraCare is an exceptional place to work! We are culturally driven to be inclusive and respectful of all opinions. We encourage diversity in thought and approach, and we welcome healthy debate. We hire partners who add to our IntraCare family versus workers.  We empower our employees and help them to achieve their personal best. This uncompromising dedication to team culture and individual development is key to our success.

Primary Job Duties:

· Prepare and submit individual provider applications, rosters, and group applications for payer enrollment, complying with all rules and instructions with high attention to detail

· Prepare and submit demographic updates as needed

· Follow up timely to check status of submitted applications

· Prepare, submit, and monitor all Medicare, Medicaid and related applications for entities

· Maintain open communication with providers, health plans, and internal stakeholders to resolve credentialing and enrollment issues related to provider files

· Maintain and organizes payer and provider document copies, NPPES/TMB/CAQH/DEA and other required profiles, as well as files that are accessible to internal stakeholders

· Maintain provider rosters and EMR/PM systems by tracking payor enrollment and onboarding information

· Research credentials in alignment with NCQA and national health plan standards as requested by HR and others to support primary source verifications need as they arise, especially for expedited onboarding of temporary or urgent need providers

· Work with internal teams to support workable business arrangements that are consistent with IntraCare’s contracting goals

· Collaborate with internal departments including but not limited to Revenue Cycle, Operations, and Human Resources to support provider onboarding, credentialing, and the maintenance of employed provider credentials

· Identify which specific health plan products are participating vs. non-participating for each provider and in relation to EMR/PM set up

· Arrange facility privileges as needed, submitting initial and renewal applications

· Maintain collaborative relations and high communication with all health plans in representation of IntraCare

· Facilitate, attend, and support Credentialing Committee as necessary, raising relevant topics

· Prepare special reports, summaries, and/or replies to inquiries by compiling data and statistics from various departmental resources

· Serve as owner and steward of the credentialing email and telephonic inbound information updates and requests, disseminating, tracking, and closing all items

· Review key health plan directories for accuracy and work with payers to make timely changes

· Obtain, centrally store, and share provider handbooks and fee schedules for access by employees

· Other duties as assigned

Qualifications

· 7+ years of experience with credentialing and payer enrollment processes

· Demonstrated track record of leadership or management that lends to managerial readiness

· Experience submitting applications on behalf of providers directly to national health plans

· High familiarity with Medicare, Medicaid, CAQH, and other standard application systems

· Highly organized and attentive to details

· Proficiency in Excel, Powerpoint, and Outlook. Access database experience a plus

· Strong written and verbal communication skills

· Collaborative nature and effective interpersonal skills

· Familiarity with Texas and Arizona state requirements preferred

JOB CODE: 1000095