Manager, Credentialing & Provider Enrollment

We are searching for a Centralized Credentialing Manager someone who works well in a fast-paced this position youll be responsible for maintaining the Practitioner and Facility Credentialing Program for Texas Childrens Medical Staff and Texas Childrens Physician Group (TCPSO). This role will be primarily responsible for maintaining policies and processes in compliance with all applicable federal state and nationally recognized regulatory and/or accrediting bodies and overseeing credentialing staff in the preparation of all credential files and reports to ensure compliance.

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Job Duties & Responsibilities

Manages a Credentialing Program that meets regulatory and accrediting body requirements
Responsible for Credentialing responses to regulatory audits
Responsible for training of Texas Childrens Centralized Credentialing staff to ensure a comprehensive up to date knowledge base for identifying potential quality regulatory or malpractice issues early in credentialing process
Responsible for credentialing and re-credentialing functions for practitioners seeking to join the Texas Childrens Medical Staff and/or become a member of the TCPSO through direct credentialing
Oversees credentialing and re-credentialing functions for practitioners privileged through the Texas Credentials Committee or approved as a member of the TCPSO accessing payors delegated agreements
Maintains a current and accurate database of all credentialed practitioners
Ensures that the credentialing and reappointment process for the Medical Staff follow Joint Commission (TJC) requirements as outlined in the TCH Bylaws and Rules and Regulations and understand the linkage between your departments requirements and those of the integrated delivery system
Ensures that NCQA requirements specific to the TCPSO Credentialing program are fulfilled and understands the linkage between the TCH Centralized Credentialing departments requirements and those of the integrated delivery system
Collaborates with colleagues in other departments to ensure all NCQA and TJC requirements are met

Skills & Requirements

High School Diploma or GED is required; Associates or Bachelors degree is preferred
A Bachelors degree may substitute for 4 years and an Associates degree may substitute for 2 years
Certified Professional Medical Services Management or Certified Provider Credentialing Specialist license is preferred
8 years experience in a healthcare delivery environment hospital physician practice physician billing credentialing managed care provider engagement and/or privileging environment required
Previous supervisory or managerial experience highly desired

**Highly Desired Skills/Knowledge: Revenue Cycle Revenue Cycle Analyst Billing Coding