Sr. Credentialing Specialist

The Senior Credentialing Specialist for Tenet Physician Resources (TPR) will be a vital member of the credentialing team at Tenet Health, specifically focused on managing the credentialing process for healthcare providers affiliated with TPR. This role will involve overseeing the lifecycle of provider credentialing, ensuring compliance with regulatory requirements, internal policies, and TPR-specific guidelines. The Senior Credentialing Specialist for TPR will play a critical role in maintaining the integrity of provider credentialing, supporting the delivery of quality care, and fostering strong relationships with TPR-affiliated providers.

• Manage the end-to-end credentialing process for healthcare providers affiliated with TPR, including initial credentialing, recredentialing, and privileging.
• Review and assess provider applications for completeness, accuracy, and adherence to TPR and regulatory standards.
• Conduct primary source verifications of provider credentials, including licensure, education, training, certifications, and professional references.
• Collaborate with TPR entities, providers, and internal stakeholders to obtain necessary information and resolve any credentialing-related issues or discrepancies.
• Ensure compliance with regulatory requirements, accreditation standards, and TPR-specific credentialing policies and procedures.
• Maintain comprehensive and up-to-date provider credentialing files, ensuring confidentiality, accuracy, and data integrity.
• Monitor and track provider expirable, such as licenses, certifications, and malpractice insurance, to ensure timely renewals.
• Participate in audits and internal quality assurance activities to identify opportunities for process improvement and enhance credentialing practices.
• Stay abreast of industry trends, changes in credentialing regulations, and best practices, providing recommendations for improvement and adaptation.
• Assist in the development and implementation of credentialing policies, procedures, and training programs specific to TPR entities.
• Provide guidance and support to junior credentialing staff members, fostering a collaborative and high-performing team environment.
   

• Bachelor's degree in healthcare administration, business administration, or a related field. Relevant certifications are a plus.
• Minimum of 5 years of experience in healthcare provider credentialing, preferably with exposure to TPR or physician practice settings.
• Strong understanding of credentialing principles, regulatory requirements, and accreditation standards (e.g., NCQA, Joint Commission).
• In-depth knowledge of TPR-specific credentialing processes, policies, and guidelines.
• Proficiency in conducting primary source verifications and assessing provider applications for accuracy and compliance.
• Familiarity with credentialing software systems and databases.
• Excellent attention to detail and organizational skills, ensuring the accuracy and completeness of credentialing files.
• Effective communication and interpersonal skills to collaborate with internal and external stakeholders, including TPR-affiliated providers.
• Ability to work independently and manage multiple priorities in a fast-paced environment.
• Strong analytical and problem-solving abilities, with a focus on process improvement and efficiency.
• Commitment to maintaining confidentiality and handling sensitive information with discretion.