Credentialing Lead
Houston, TX - USA
Job Summary
- Oversee and execute all credentialing and recredentialing activities for medical providers including verification of education training licensure certifications work history and malpractice coverage.
- Ensure full compliance with NAMSS (National Association Medical Staff Services) accreditation standards as well as federal state and payer requirements.
- Maintain accurate and up to date provider files within credentialing databases and systems.
- Conduct primary source verification (PSV) and ensure timely follow up on outstanding items.
- Prepare credentialing files for committee review and support Medical Staff Office operations as needed.
- Collaborate with providers and managers to resolve credentialing issues and ensure timely onboarding.
- Maintain copies of current state licenses DEA certificates malpractice coverage and any other required credentialing documents for all providers as well as track all state license DEA and board certification expirations for all providers to ensure timely renewals.
- Monitor expiring credentials and proactively manage renewal processes.
- Participate in audits quality improvement initiatives and policy development related to credentialing standards.
- Generate reports and maintain documentation to support compliance and accreditation readiness.
- Develop and implement credentialing policies and procedures to ensure compliance with federal and state regulations and accreditation standards.
- Serve as a subject matter expert on credentialing issues and provide training to internal stakeholders as needed.
- Demonstrate excellent written/oral communication skills
- Identify and assist with opportunities for performance improvement activities.
- Demonstrate positive behaviors interactions and attitude.
- Comply with Safety Health and Environmental plan; must be committed to a high standard of safety and be willing and able to comply with all safety laws and all of the Companys safety policies and rules and must be willing to report safety violations and potential safety violations to appropriate supervisory or management personnel.
- Comply with the Quality Assurance Plan policies and procedures.
- Maintain regular and acceptable attendance level as determined by the Company.
- Complete all assigned training.
- Attend or lead meetings as required.
- Fulfill the duty and responsibility to maintain competence and to continue personal and professional growth.
- Other duties as assigned.
- Bachelors degree in healthcare administration business administration or a related field
- Minimum of 5 years of experience in medical staff credentialing provider enrollment or related healthcare administrative roles.
- NAMSS accreditation (CPCS or CPMSM) required.
- Strong knowledge of regulatory and accreditation standards including CMS Joint Commission NCQA and state-specific requirements.
- Proficient with credentialing software systems and databases
- Experience working in a hospital health system or large multi-specialty practice.
- Previous use of MD Staff credentialing software.
- Advanced skills in data management and reporting.
- Previous NASA experience a plus
- Excellent communication organizational and analytical skills.
- Ability to manage multiple priorities and meet strict deadlines.
- Ability to lead physician-attended meetings and advocate for adherence to best practices in a non-traditional setting
- Ability to work independently and assume assigned responsibilities
- Ability to deal with problems involving non-traditional work settings
- Ability to handle confidential information
About Company
Craig Technologies is an aerospace and defense engineering firm providing services to both government and commercial customers including multidisciplinary engineering; systems engineering and integration; software design and development; IT support; cybersecurity; training and coursew ... View more