About Texicare

Founded in 2023 as a mission-driven health affiliate of Texas Mutual, Texicare was created by a group of seasoned healthcare professionals, and is headquartered in Austin, Texas. 

Texicare is committed to changing the healthcare landscape by providing small businesses with innovative solutions that increase access to easy-to-use, more affordable, quality health care for Texans and their families. Texicare’s vision is to transform the healthcare ecosystem for the better, helping to create a healthier and happier Texas.  Our healthcare plans were designed to be used, to remove barriers to care, to truly make a difference in people’s lives. 

We’re looking for passionate, mission-driven individuals to join us in creating a healthier and happier Texas.

About the role

As a member of the Network Development team, you will be responsible for overseeing the intake, processing, and maintenance of provider credentialing, ensuring compliance with industry regulations, and collaborating with various departments to enhance network operations. The ideal candidate should be highly organized, possess excellent analytical skills, have strong attention to detail, and a thorough understanding of provider data management from a payer perspective.

In this role, you will be responsible for:

Provider Intake and Data Management

• Manage the intake of providers into the credentialing process, including querying Council for Affordable Quality Healthcare (CAQH) and entering provider information into the data management system.

• Requests and collects all necessary credentialing data and supporting documents from providers to support Credentialing Vendor Organization (CVO).

Process Monitoring and Compliance

• Monitor the progress of providers through the credentialing process.

• Maintain compliance with National Committee for Quality Assurance (NCQA) standards, delegated credentialing, and Primary Source Verification requirements.

Collaboration and Communication

• Work closely with the Network team on all new providers in the pipeline.

• Communicate delays or issues in the credentialing process to the Network team to avoid project timeline disruptions.

• Serve as a liaison in resolving provider issues and ensure positive working relationships.

Data Integrity and System Optimization

• Promote data integrity and optimize the effectiveness of the provider data management system.

• Support the implementation of new database modules, including data migration, validation, and mapping to reports.

Training and Support

• Provide training related to credentialing and the provider data management system to enhance team knowledge and skills.

• Assist the IT team in creating the provider directory for the plan.

Special Projects

• Oversee special projects, including providing project plans, anticipating concerns, and delivering regular updates to leadership.

• Develop strategic departmental goals in collaboration with the Manager of Network Operations and Senior Directors.

To be successful in this role, you should have:

• Associate’s degree in business, marketing, a related field, or equivalent experience. Bachelor’s degree preferred.

• 5+ years of experience in a managed care role, centralized credentialing office, or related healthcare environment

• Knowledge of health plan and governmental payer credentialing, enrollment, and requirements

• Familiarity with CAQH applications and contract language interpretation

• Ability to work in a deadline-intense environment

• Demonstrated problem-solving and customer service skills

• Proficiency in Microsoft Word, Excel, and other PC applications

• Excellent verbal and written communication skills

• Ability to work in our south Austin office on a hybrid schedule

• Certification as a Certified Provider Credentialing Specialist (CPCS) preferred

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

Texicare is an Equal Employment Opportunity employer.