**Hours of Work :** 8:00 am - 4:30 pm **Days Of Week :** M-F **Work Shift :** 8X5 Day (United States of America) **Job Description :** **Reports To:** _Credentialing Manager_ **Inclement Weather Status** ☐ Required to report to work ☒ Not required to report to work **Job Summary** ☒ Category A: Employee with no patient impact ☐ Category B: Employee with patient impact ☐ FLSA: Exempt ☒ FLSA: Non-exempt **Job Purpose:** _Knowledge of payer enrollment and managed care principles in compliance with NCQA, URAC, TDI and CMS Standards including Texas Administrative Codes pertaining to credentialing and payer enrollment to coordinate enrollment, data integrity, accuracy and consistency of practitioners’ information with the managed care plans, Medicare and Medicaid. Knowledge of managed care processes and delegated credentialing is required along with knowledge of Medicare and Medicaid enrollment processes._ _Related Work Experience and Other Skills • Ability to multitask with minimal errors and utilize critical thinking skills. • Must be able to maintain the confidentiality of data. • Must be detail oriented, organized, self-starter, and have an ability to prioritize workload. • Ability to_ _analyze and interpret data and solve practical problems in independent and team environments. • Ability to work under deadlines and manage multiple projects while completing work in an accurate and timely manner. • Strong verbal and written communication skills._ **Age Specific Care Considerations:** ☐ Adults: 18+ years – 35 years ☐ Adults: 35+ years – 65 years ☐ Adults: 65+ years ☐ Children A: 18+ months – 3 years ☐ Children B: 3+ years – 5 years ☐ Children C: 5+ years – 12 years ☐ Children D: 12+ years – 18 years ☐ Infants: 0 – 18 months ☒ Not applicable (category A employee) **Education:** _Some college or college degree preferred but not required._ **Licenses and/or Certifications (Required and Preferred):** _Click here to enter text._ **Related Work Experience and Other Skills:** _Minimum of 5 years of managed care experience required. Experience enrolling_ _practitioners in Medicare and Medicaid and working with various managed care networks._ **Physical Demands and Work Environment:** _Office environment that requires sitting at a computer for extended periods of time._ **Job Roles** (Recommend no more than 10 job duties.) Duty 1: _Responsible for completing Medicare and Medicaid enrollment for employed practitioners and groups along with tracking and completing revalidation applications prior to the due date._ Duty 2: _Responsible for practitioner file maintenance in MD Staff and with the managed care plans, Medicare and Medicaid, including but not limited to all adds, changes and terms and any other managed care, Medicare or Medicaid required data._ Duty 3: _Responsible for providing monthly, quarterly or semi-annual practitioner rosters and credentialing summaries to delegated managed care plans._ Duty 4: _In coordination with managed care plans, update and maintain health plan grids in MD Staff of practitioners’ contracted health plans and communicate regular updates to practitioners’ offices._ Duty 5: _Working closely with department staff and practitioner office staff to review and respond to any practitioner enrollment or network issues to identify and resolve root cause._ Duty 6: _Responsible for completing and maintaining accurate and current information in employed practitioners’ CAQH profiles._ Duty 7: _Assist with roster reconciliation projects with managed care plans._ Duty 8: _Build customized reports, create customized forms, and create complex queries_ . Duty 9: _Click here to enter text._ Duty 10: _Click here to enter text._ zOther duties as assigned. Methodist Health System is a faith-based organization with a mission to improve and save lives through compassionate, quality healthcare. For nearly a century, Dallas-based Methodist Health System has been a trusted choice for health and wellness. Named one of the fastest-growing health systems in America by _Modern Healthcare_ , Methodist has a network of 12 hospitals (through ownership and affiliation) with nationally recognized medical services, such as a Level I Trauma Center, multi-organ transplantation, Level III Neonatal Intensive Care, neurosurgery, robotic surgical programs, oncology, gastroenterology, and orthopedics, among others. Methodist has more than two dozen clinics located throughout the region, renowned teaching programs, innovative research, and a strong commitment to the community. Our reputation as an award-winning employer shows in the distinctions we’ve earned: + Magnet® designations for Methodist Dallas, Methodist Charlton, Methodist Mansfield, and Methodist Richardson Medical Centers + 150 Top Places to Work in Healthcare by _Becker’s Hospital Review_ , 2023 + Top 10 Military Friendly® Employer, Gold Designation, 2023 + Top 10 Military Spouse Friendly® Employer, 2023 Methodist Health System is a faith-based organization with a mission to improve and save lives through compassionate, quality healthcare. For nearly a century, Dallas-based Methodist Health System has been a trusted choice for health and wellness. Named one of the fastest-growing health systems in America by _Modern Healthcare_ , Methodist has a network of 12 hospitals (through ownership and affiliation) with nationally recognized medical services, such as a Level I Trauma Center, multi-organ transplantation, Level III Neonatal Intensive Care, neurosurgery, robotic surgical programs, oncology, gastroenterology, and orthopedics, among others. Methodist has more than two dozen clinics located throughout the region, renowned teaching programs, innovative research, and a strong commitment to the community. Our reputation as an award-winning employer shows in the distinctions we’ve earned: + Magnet® designations for Methodist Dallas, Methodist Charlton, Methodist Mansfield, and Methodist Richardson Medical Centers + 150 Top Places to Work in Healthcare by _Becker’s Hospital Review_ , 2023 + Top 10 Military Friendly® Employer, Gold Designation, 2023 + Top 10 Military Spouse Friendly® Employer, 2023 Equal Opportunity Employer It is the policy of Methodist Health System (MHS) to select, develop, and promote employees based on individual ability and job performance. It has been, and will continue to be, the policy of MHS to provide equal employment opportunity to all people in all aspects of employer-employee relations without discrimination because of race, color, religion, national origin, age, sex, sexual orientation, gender expression, disability, marital status, genetic information or ancestry. This policy affects decisions including, but not limited to, an employee’s compensation, benefits, terms and conditions of employment, opportunities for promotion, training, development, transfer all other privileges of employment. MHS is committed to maintain a working environment free of intimidation, workplace discrimination and harassment. Retaliation or attempted retaliatory behavior that occurs as a result of an employee’s exercise of their rights under this policy or any other statutorily protected right is strictly prohibited and will be grounds for disciplinary action.