Senior Enrollment & Credentialing Liaison at Texicare

Austin, Texas, United States -

Full Time

Start Date

Immediate

Expiry Date

21 Jan, 26

Salary

0.0

Posted On

23 Oct, 25

Experience

5 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Credentialing, Data Management, Compliance, Customer Service, Problem-Solving, Microsoft Word, Microsoft Excel, CAQH ProView, Verisys, NCQA Standards, Provider Enrollment, Regulatory Standards, Delegated Credentialing, Healthcare Providers, Reporting, Relationship Management

Industry

Insurance

Description

Position Summary We are seeking an experienced and detail-oriented Enrollment & Credentialing Liaison to join our team. This role will oversee and optimize the day-to-day operations of our health plan, managing the entire lifecycle of provider credentialing, data management, and enrollment while ensuring compliance with regulatory standards. As part of the Network Operations team at Texicare in Austin, Texas, this hybrid role allows for remote work with occasional on-site training and meetings. The ideal candidate will be proactive, thrive in a collaborative environment, and effectively manage multiple tasks. Candidates should possess a strong background in credentialing, including hands-on experience with primary source verification and a proven understanding of The Council for Affordable Quality Healthcare (CAQH) ProView, Verisys, and National Committee for Quality Assurance (NCQA) standards. Familiarity with credentialing software and experience in delegated credentialing are advantageous. We are looking for a proactive, highly organized, and detail-oriented individual. This role will report to the Manager of Network Operations. Essential Job Functions In this role, you will: Credentialing & Provider Enrollment: Manage complex credentialing and re-credentialing processes for new and existing healthcare providers. Coordinate with the Credentialing Verification Organization (CVO) and ensure timely submission of enrollment applications. Manage the provider enrollment process for physicians, mid-level practitioners, ancillary staff, and hospitals, encompassing both direct and delegated credentialing responsibilities. Data Management & Compliance: Maintain and update provider data across internal systems, while ensuring adherence to regulatory standards. Develop and deliver reports to leadership on enrollment and credentialing progress, proactively identifying, researching, and resolving delays or discrepancies. Develop and deliver reports to leadership on enrollment and credentialing progress, proactively identifying, researching, and resolving delays or discrepancies. Monitoring & Reporting: Track the progress of providers through the credentialing process. Lead data migration and validation efforts. Monitor renewal and re-validation processes to prevent lapses in coverage or billing privileges. Compliance & Regulatory Adherence: Stay informed about local, state, and federal regulations affecting provider enrollment and credentialing. Customer Service: Resolve credentialing-related inquiries and issues while delivering exceptional service to providers. Develop and maintain strong relationships with practice representatives to facilitate efficient resolutions to credential obstacles. To be successful in this role, you must have: An associate degree or any equivalent combination of education, training, and experience. At least 4 years of experience in a managed care role, centralized credentialing office, or related healthcare environment or any equivalent combination of education, training, and experience. Knowledge of health plans and governmental payer credentialing, enrollment, and requirements Familiarity with CAQH applications and contract language interpretation Demonstrated problem-solving and customer service skills Proficiency in Microsoft Word, Excel, and other PC applications It would be great if you have: A bachelor’s degree. Certification as a Certified Provider Credentialing Specialist (CPCS). Benefits Automatic 4% employer contribution to retirement plan 401k plan with 100% match up to 6% Flexible time off for vacation, illness, etc. Nine paid holidays Day one health, Rx, vision, and dental insurance Life and disability insurance Flexible spending account Pet coverage and pet Rx discounts Free identity theft protection Free 2nd medical opinion service Location Texicare offers a flex-hybrid environment centered around collaboration and connection. All employees must reside in Texas. Team members living in the Austin area are expected to work from our office at least two days per week. Those based outside the greater Austin area may work remotely within Texas, with occasional travel to Austin as needed. Texicare is an equal opportunity employer.

Responsibilities

Manage the entire lifecycle of provider credentialing and enrollment while ensuring compliance with regulatory standards. Develop and deliver reports on enrollment and credentialing progress, proactively resolving any issues that arise.