Staff members from Prism health North Texas Oak Cliff Health Center Clinic

Credentialing Manager JobDallas, TX

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Why You'll Love This Job

General description:
The Credentialing Leader is responsible for all aspects of the credentialing, re-credentialing, and privileging process for over 35 physicians, physician assistants, nurse practitioners, dentists, dental hygienists, licensed professional counselors, licensed clinical social workers, and all other licensed care providers who provide patient care services at Prism Health North Texas (“PHNTX”) and Uptown Physician Group (“UPG”), as well as ensuring enrollment with participating health and dental plans.
The credentialing process includes, but is not limited to, assisting clinical providers with completion of the  initial credentialing applications during the onboarding process, performing primary source verifications, and maintaining credentialing online databases in accordance with internal policies and procedures. Once submitted, the Credentialing Leader also works to ensure all credentialing and privileging remain up-to-date and accurate. The Credentialing Leader also serves as the primary point of contact for all contracting matters related to health and dental plans. The organization’s operational budget is $120 million which nearly all is reliant and dependent on effective credentialing, privileging, and contracting.


Specific Responsibilities of the Job:
  • Leads the organization’s credentialing and privileging activities on behalf of all licensed clinical providers.
  • Remains accountable as the organization’s lead towards accurate and up-to-date provider credentialing.
  • Writes and implements the organization’s credentialing and privileging procedures.
  • Provides direction to all team members, including executive staff, physicians, and finance/billing team for how credentialing and privileging supports the organization’s mission.
  • Independently, with little needed direction, develops, maintains, and measures key performance indicators related to the organization’s credentialing and privileging effectiveness.  
  • Responsible for gathering, verifying, and evaluating highly confidential and sensitive health care practitioner credentialing information in a manner that is consistent with departmental guidelines and accreditation standards.
  • Responsible for responding to all practitioner, client health plans, and internal inquiries in a timely manner.
  • Leads the organization’s efforts towards direct contract negotiations with health and dental plans, and serves as the chief point of contact for all contractual matters under the direction of key executive leadership staff.
  • Maintains accurate provider profiles on CAQH, NCQA, PECOS, NPPES, and CMS databases, as needed.
  • Other duties as assigned.

Skills & Qualifications

Required Knowledge, Skills and Abilities:
  • Must have prior experience leading a credentialing department responsible for credentialing and privileging of multi-specialty clinical providers.
  • Prior experience working with health plans for contract negotiations is preferred, demonstration of achievement towards value-based incentives or preferred provider listings is also preferred.
  • Excellent leadership and relationship skills that are results oriented and mission driven.
  • Demonstrated experience in working with practice management software.
  • Demonstrated ability to manage multiple responsibilities in a complex environment.
  • Proficiency in MS Office, excel, word, etc.
  • Must be able to coordinate effectively between multiple departments.
  • Excellent written and oral communication skills.
Education and Experience:
  • Certified Provider Credentialing Specialist (CPCS), or equivalent certification required.
  • Bachelor’s degree preferred.
  • 5 years of experience credentialing in a comprehensive and specialty care environment; preference will be given to individuals with Federally Qualified Health Center credentialing and contracting experience.
  • 5 years of experience in a management role.
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