Credentialing Specialist
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Job Location:
Houston, MS - USA
Monthly Salary:
Not Disclosed
Posted on:
30+ days ago
Vacancies:
1 Vacancy
Job Summary
Were searching for a Centralized Credentialing Specialist someone who works well in a fast-paced this position you will be the single point of contact and responsible for managing and completing all credentialing functions related to the Provider On-Boarding process for members of the Medical Staff and the Physician Services Organization. Responsible for ensuring providers presented to the Credentials Committee and Executive Vice President are highest quality in accordance with Bylaws and Mission Joint Commission (JC) standards and National Council of Quality Assurance (NCQA) guidelines.
Think youve got what it takes
Job Duties & Responsibilities
Determines applicants eligibility for membership/participation with Medical Staff & Physician Services Organization.
Analyzes application and supporting documents for adherence to Joint Commission (JC) National Council for Quality Assurance (NCQA) regulatory standards and managed care delegated agreements.
Recognizes investigates and validates discrepancies and adverse information obtained from the application primary source verifications or other identified sources to ensure that review and approval bodies have the information needed to make informed credentialing decisions.
Compiles evaluates and presents the practitioner-specific data collected and assembled during the verification process for review to the approving Section Chief Department In Chief and Credentials Committee.
Creates summary of findings prepare verification documentation and notify Legal Counsel Section Chief and Credentials Committee Chair within 24 hours of red flag identification.
When temporary privileges are requested analyzes application and determines if the applicant meets the minimum requirements; notifies Executive Vice President provides provider details and requests approval.
Regularly obtains evaluates and communicates to provider and departmental leadership licensure information from primary sources. Suspends privileges and membership within 24 hours of non-compliance as documented in Bylaws Rules & Regulations and Credentialing policies.
Initiates provider access and training to all applicable systems and resources.
When Urgent/One Time privileges are requested responsible for immediate review analysis of application and communication of immediate patient care needs to the Credentials Committee Chair Service physician leadership and Executive Vice President; Submits all provider access requests and follow up with approving departments including internal leadership.
Ensures compliance with Bylaws credentialing policies government regulations and accreditation and regulatory standards.
Provides education for on-boarding providers and key stakeholders.
Provides reporting on provider credentialing reappointments and various other reports as requested.
Effectively communicates and appropriately represents the provider facility and physician group.
Skills & Requirements
High School Diploma or GED required
Bachelors Degree Business Finance Healthcare Administration or Accounting preferred
CPMSM - Cert-Cert PROF Med Servic Mgmt preferred
A Provider Enrollment Specialist Certificate (PESC) from DecisionHealth preferred
4 years Experience in a physician practice physician billing hospital or managed health care setting required
1-year Presentations summary reports and/or committee participation preferred
A bachelors degree in finance Accounting Business or Healthcare Administration may substitute for 2 years of experience. An associates degree may substitute for 1 year of experience.
Required Experience:
IC
Key Skills
- Sales Experience
- Crane
- Customer Service
- Communication skills
- Heavy Equipment Operation
- Microsoft Word
- Case Management
- OSHA
- Team Management
- Catheterization
- Microsoft Outlook Calendar
- EHS
About Company
Since 1954, Texas Children’s has been leading the charge in patient care, education and research to accelerate health care for children and women around the world. When you love what you do, it truly shows in the smiles of our patient families, employees and our numerous accolades suc ... View more
