Tenet Healthcare Corporation

Credentialing Manager

Tenet Healthcare Corporation • $88K — $105K *
Dallas, TX 75217In-Person
Healthcare
5 - 7 years of experience
Today
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Job Overview by Ladders

Qualifications

  • 5-10 years of managed care experience with a focus on health plan/provider contracting.
  • 5+ years in a credentialing leadership role.
  • Strong analytical skills with the ability to communicate across all organizational levels.
  • In-depth knowledge of payer credentialing and medical claims processing.
  • Experience with primary source verification and NCQA credentialing requirements.
  • Proficient in credentialing software, particularly Echo or Athena, and MS Office tools.

Responsibilities

  • Manage credentialing worklists to resolve RCM issues before claims are deemed 'dead' by the Health Plan.
  • Foster relationships to drive claims projects toward successful closure.
  • Enhance health plan partner relationships to support onboarding and acquisitions initiatives.
  • Conduct root cause analysis daily to ensure efficient claims payment and patient access.
  • Lead team training programs for initial and ongoing education in a dynamic work environment.

Benefits

  • Collaborative work environment focused on continuous improvement.
  • Professional development opportunities for leadership growth.
  • Engagement with top payor partners nationally and regionally.
  • A chance to influence departmental processes and strategic initiatives.
Full Job Description
Job Description

POSITION SUMMARY
  • The Credentialing Manager will be responsible for managing provider credentialing/re-credentialing, understanding the intricacies of payor credentialing while also having the ability to identify and resolve complex claims issues. The ideal candidate will have experience in both credentialing and medical claims, with a strong understanding of healthcare regulations, payer requirements, and revenue cycle workflows.
  • The Credentialing Manger will work closely with the National Director of Credentialing to define departmental processes, execute strategic departmental initiatives, and have the ability to communicate high-level issues to Leadership when needed to ensure barriers do not hinder progress and implementation.
  • The Credentialing Manager will act as a liaison between internal departments, (operations/onboarding/Conifer/RCM, managed care) and health plan partners to and diagnose/resolve claim issues, educate, and work to ensure credentialing activity across the department was successful through claims payment. This position provides oversight of the Credentialing Worklists and metrics across Athena in addition to desperate platforms and manages the day-to-day relationships with all. This position also ensures the team meets timelines and KPIs around Revenue Cycle and manages/retrains when performance metrics are not met.
  • The candidate will have the ability to define SOPs around credentialing/claims collaboration, structure definition, issue resolution and workflows.
  • The Credentialing Manager will have an in-depth understanding of Revenue Cycle, Managed Care, Credentialing and claims processing to perform root-cause analysis and quickly resolve issues that stagnate claims payment and payment access issues.
  • The Credentialing Manager will have the ability to effectively communicate to all levels internally and externally as well as produce and present productivity reports and discuss mitigation plans through to resolution.
  • The Manager will elevate health plan relationships to ensure issues are resolved quickly. This requires the individual to represent TPR physicians with all of National Leaders for our top payors within each market as well as nationally to include Aetna, Humana, United, Cigna, Blue Cross/Blue Shield, and Aetna as well as other regional and local plans.
  • The manager will have direct reports.


Responsibilities

  • Provide oversight and management of the credentialing worklists in Athena to resolve RCM issues impacted by credentialing are being prioritized, worked through to resolution and resolved prior to the claim is rendered "dead" by the Health Plan.
  • Elevating relationships to drive claims projects to successfully closed/paid.
  • Elevate Health Plan partner relationships to drive internal strategies around onboarding and acquisitions by representing TPR with accurate data input/submissions, challenging payor agendas, and timely project completion.
  • Prioritize root cause analysis and problem-solving daily to ensure claims payment is successful and patient access is never hindered due to administrative challenges.
  • Lead all training needs for the team within the manager's scope - initial training as well as retraining to ensure the right tools and knowledge are provided to the team to continually drive success and excellence through a consistently changing environment.


Qualifications

Knowledge, Skills, Abilities

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The list below are representative of the knowledge, skill and/or ability. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.

Required:
  • Excellent analytical abilities and communication skills including the ability to communicate with stakeholders and decision-makers across the spectrum of the organization, from senior business leaders to subordinates
  • Experience in progressive health care management with emphasis in health plan/provider contracting and physician group management/contracting
  • In Depth knowledge of health plan and governmental payer credentialing, enrollment, medical claims payment and requirements.
  • Ability to work within a deadline-intense environment.
  • Demonstrated problem-solving and customer service skills.
  • Knowledge of primary source verification, provider enrollment, and NCQA credentialing requirements.
  • Proficient working knowledge of Echo or other credentialing systems, Athena and MS Office Suite of products including but not limited to Word, Excel, Project, and PowerPoint.

Preferred:
  • Experience with multi-specialty or large group practices across multiple states/Tax IDs
  • Bachelor's degree in healthcare management, public health, accounting, finance, business, social or behavioral sciences preferred or equivalent experience
  • 7-10 years of previous managed care experience and 5+ years' experience in a credentialing leadership role


Education/Experience

Required:
  • Bachelor's degree in healthcare management, public health, accounting, finance, business, social or behavioral sciences preferred or equivalent experience
  • 7-10 years of previous managed care experience and 5+ years' experience in a credentialing leadership role


About Tenet Healthcare Corporation

Tenet Fintech Group is an innovative Fintech service provider to the Chinese commercial lending sector.

Tenet Healthcare Corporation Careers

Join the dedicated team at Tenet Healthcare Corporation, a national leader in healthcare services. At Tenet, we are committed to providing the highest quality care and outstanding patient experiences. This commitment extends to our team members in every role across our network.

Work You’ll Do

At Tenet Healthcare Corporation, you will be part of a dynamic team that is passionate about transforming healthcare. Our professionals enjoy a collaborative environment where innovative ideas and a proactive approach to healthcare are at the forefront of what we do.

Explore Job Opportunities and Growth

We offer a variety of job opportunities across clinical, administrative, and corporate disciplines. Whether you are a seasoned professional or just starting your career, Tenet provides a path for growth and development. Our leadership is committed to nurturing talents through advanced training programs, leadership workshops, and continuous professional development.

Innovate and Lead

Join us and contribute to a culture of innovation and continuous improvement. At Tenet, every team member is empowered to make a difference. With access to cutting-edge technology and a network of professionals, you will have the tools to drive real change in healthcare delivery.

Diversity and Inclusion

At Tenet Healthcare Corporation, we celebrate diversity and are committed to creating an inclusive environment for all employees. Our diversity training ensures that our team is respectful, inclusive, and equipped to support the diverse communities we serve.

Internship Programs

Kickstart your career with Tenet’s internship programs. These opportunities allow you to gain hands-on experience while working alongside seasoned professionals. Internships are a great way to develop skills, enhance your resume, and build a network within the healthcare industry.

Benefits and Culture

Our employees enjoy a range of benefits designed to support their physical, financial, and emotional well-being. Join a company that values work-life balance, provides competitive healthcare benefits, and supports your personal and professional growth.

Join Our Team

Are you ready to advance your career in a vibrant healthcare environment? Explore the positions available at Tenet Healthcare Corporation and find where your skills and passion can make a difference. We are actively hiring and looking for individuals who are curious, creative, and eager to drive innovation in healthcare.

Stay Connected

Keep up to date with the latest at Tenet by following our careers blog. Gain insights from our team, learn about our culture, and get tips for your job search and career development.

Networking and Professional Development

At Tenet, networking and professional development are part of our ethos. We encourage our employees to connect, share, and grow together. Enhance your career through comprehensive training, mentorship, and collaboration across our extensive healthcare network.

Apply Now

Discover the rewarding career opportunities at Tenet Healthcare Corporation. Personalize your job search and apply for positions that match your qualifications and interests. Join us in our mission to provide quality care and make a positive impact in the lives of our patients and communities.

SEARCH TENET HEALTHCARE JOBS

Embark on a fulfilling career journey at Tenet Healthcare Corporation, where your growth is our priority, and your potential is limitless.
Learn more about Tenet Healthcare Corporation
Size
76,836 employees
Market Cap
$5.1 billion
Industry
Healthcare
Net Income
$399 million
Founded
1967
5 Year Trend
-0.1%
Revenue
$17.6 billion
NASDAQ
THC
* Ladders Estimates

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