UT Austin

Payer Credentialing Specialist

AUSTIN, TX Full time

Job Posting Title:

Payer Credentialing Specialist

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Hiring Department:

Dell Medical School

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Position Open To:

All Applicants

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Weekly Scheduled Hours:

40

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FLSA Status:

Non-Exempt

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Earliest Start Date:

Immediately

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Position Duration:

Expected to Continue

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Location:

AUSTIN, TX

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Job Details:

PURPOSE

The Payer Credentialing Specialist is responsible for managing the credentialing and re-credentialing processes for healthcare providers with various insurance payers. This role ensures that all provider credentials are accurate, up-to-date, and compliant with regulatory standards. 

RESPONSIBILITIES

Credentialing & Re-Credentialing

  • Manage the initial credentialing and re-credentialing processes for healthcare providers.
  • Verify provider credentials, including education, licensure, and certifications.
  • Ensure compliance with payer requirements and regulatory standards.

Provider Enrollment

  • Submit and track provider enrollment applications with insurance payers.
  • Follow up with payers to resolve any issues or delays in the enrollment process.
  • Maintain accurate records of enrollment status and documentation.

Data Management

  • Maintain and update credentialing databases and provider files.
  • Generate reports on credentialing status and compliance metrics.
  • Ensure data accuracy and integrity in all credentialing records.

Communication & Coordination

  • Communicate with providers, payers, and internal departments to facilitate the credentialing process.
  • Address and resolve any credentialing-related inquiries or issues.
  • Provide regular updates to stakeholders on credentialing status.
  • Conduct audits with payers as per delegated credentialing agreements and implement corrective action plans as needed.

Compliance & Quality Assurance

  • Ensure compliance with all regulatory and accreditation requirements.
  • Participate in audits and quality assurance activities.
  • Implement process improvements to enhance credentialing efficiency and accuracy.

REQUIRED QUALIFICATIONS:

  • High School Diploma/GED
  • At least 2 year(s) of experience in healthcare credentialing or provider enrollment.

Relevant education and experience may be substituted as appropriate.

PREFERRED QUALIFICATIONS:

  • Associate's Degree in healthcare administration or related field.
  • At least 4 year(s) of experience in payer credentialing or medical staff services.
  • Certified Provider Credentialing Specialist (CPCS) from NAMSS

SALARY RANGE

$50,000 + depending on qualifications

WORKING ENVIRONMENT/EQUIPMENT

• Standard office environment

• Repetitive use of a keyboard

Required Materials

  • Resume/CV

  • 3 work references with their contact information; at least one reference should be from a supervisor

  • Letter of interest

Important for applicants who are NOT current university employees or contingent workers: You will be prompted to submit your resume the first time you apply, then you will be provided an option to upload a new Resume for subsequent applications. Any additional Required Materials (letter of interest, references, etc.) will be uploaded in the Application Questions section; you will be able to multi-select additional files. Before submitting your online job application, ensure that ALL Required Materials have been uploaded.  Once your job application has been submitted, you cannot make changes.

Important for Current university employees and contingent workers: As a current university employee or contingent worker, you MUST apply within Workday by searching for Find UT Jobs. If you are a current University employee, log-in to Workday, navigate to your Worker Profile, click the Career link in the left hand navigation menu and then update the sections in your Professional Profile before you apply. This information will be pulled in to your application. The application is one page and you will be prompted to upload your resume. In addition, you must respond to the application questions presented to upload any additional Required Materials (letter of interest, references, etc.) that were noted above.

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Employment Eligibility:

Regular staff who have been employed in their current position for the last six continuous months are eligible for openings being recruited for through University-Wide or Open Recruiting, to include both promotional opportunities and lateral transfers. Staff who are promotion/transfer eligible may apply for positions without supervisor approval.

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Retirement Plan Eligibility:

The retirement plan for this position is Teacher Retirement System of Texas (TRS), subject to the position being at least 20 hours per week and at least 135 days in length.

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Background Checks:

A criminal history background check will be required for finalist(s) under consideration for this position.

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Equal Opportunity Employer:

The University of Texas at Austin, as an equal opportunity/affirmative action employer, complies with all applicable federal and state laws regarding nondiscrimination and affirmative action. The University is committed to a policy of equal opportunity for all persons and does not discriminate on the basis of race, color, national origin, age, marital status, sex, sexual orientation, gender identity, gender expression, disability, religion, or veteran status in employment, educational programs and activities, and admissions.

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Pay Transparency:

The University of Texas at Austin will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information.

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Employment Eligibility Verification:

If hired, you will be required to complete the federal Employment Eligibility Verification I-9 form.  You will be required to present acceptable and original documents to prove your identity and authorization to work in the United States.  Documents need to be presented no later than the third day of employment.  Failure to do so will result in loss of employment at the university.

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E-Verify:

The University of Texas at Austin use E-Verify to check the work authorization of all new hires effective May 2015. The university’s company ID number for purposes of E-Verify is 854197. For more information about E-Verify, please see the following:

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Compliance:

Employees may be required to report violations of law under Title IX and the Jeanne Clery Disclosure of Campus Security Policy and Crime Statistics Act (Clery Act). If this position is identified a Campus Security Authority (Clery Act), you will be notified and provided resources for reporting. Responsible employees under Title IX are defined and outlined in HOP-3031.

The Clery Act requires all prospective employees be notified of the availability of the Annual Security and Fire Safety report. You may access the most recent report here or obtain a copy at University Compliance Services, 1616 Guadalupe Street, UTA 2.206, Austin, Texas 78701.