ABOUT AUSTIN REGIONAL CLINIC:

Austin Regional Clinic has been voted a top Central Texas employer by our employees for over 10 years! We are one of central Texas’ largest professional medical groups with 25 locations and we are continuing to grow. We offer the following benefits to eligible team members: Medical, Dental, Vision, Flexible Spending Accounts, PTO, 401(k), EAP, Life Insurance, Long Term Disability, Tuition Reimbursement, Child Care Assistance, Health & Fitness, Sick Child Care Assistance, Development and more. For additional information visit https://www.austinregionalclinic.com/careers/

PURPOSE: Participates in/performs the credentialing and recredentialing processes for Austin Regional Clinic and external providers to ensure credentialing/re-credentialing/projects are completed in a timely manner and meet the standards as set forth in the Credentialing Policies and Procedures and NCQA compliance. Promotes Provider confidentiality and supports the mission and philosophy of the organization.

ESSENTIAL FUNCTIONS:

• Gathers, researches, compiles and documents physician data used in the Credentialing process.
• Investigates discrepancies, reports and documents findings.
• Maintains databases/records of required Provider information, including but not limited to licensures and documents.
• Performs new Provider Credentialing activities including preparation of new Provider files to be presented to the Board or Credentialing Committee per NCQA Standards.
• Ensures new Providers have hospital membership at all appropriate hospitals within the allotted time frame.
• Ensures new Provider applications (Medicare/Medicaid/Tricare/TCMS/TMA, etc) are submitted timely and follows to completion.
• Performs the recredentialing process to ensure all Providers are re-credentialed within the recredentialing renewal cycle. Assist in preparing reports of any discrepancies to the Board or Credentialing Committee.
• Ensures hospital privilege applications are sent to the appropriate facilities in a timely manner and addresses additional requests relating to such as necessary.
• Ensures Credentialing Files are kept current and orderly.
• Monitors/ tracks Medicare and Medicaid enrollment process. Addresses necessary issues regularly.
• Audits coworkers completed files/projects as needed.
• Monitors licensure/insurance expiration date activity for both internal and external Providers.
• Monitors all required regulatory websites as required by NCQA Standards. Documents findings. Reports any issues identified to Supervisor.

OTHER DUTIES AND RESPONSIBILITIES:

• Provides regular workload/productivity reports to supervisor.
• Responds professionally and effectively to questions from internal and external sources (ie. Customers, Insurance Companies, Providers, Management, etc)
• Attends required inservices/training sessions/department meetings.
• Performs other duties as assigned.

MINIMUM QUALIFICATIONS:

Education: High school diploma or GED equivalent.

Experience: One (1) or more years successful clerical experience. Experience working in credentialing and/or medical office preferred. Experience using credentialing software preferred.

Knowledge, Skills, and Abilities:

• Must have excellent verbal and written communication skills in order to communicate clearly and effectively to all levels of staff and the public.
• Ability to sit for extended periods of time at a computer workstation.
• Ability to stand for extended periods of time for filing/scanning.
• Must have excellent attention to detail & organizational skills.
• Excellent customer service skills.
• Excellent interpersonal & problem solving skills.
• Ability to work in a team environment.
• Ability to manage competing priorities.
• Excellent computer skills and knowledge of Microsoft Office programs.

Work Schedule: Monday to Friday 8am to 5pm