Credentialing Specialist

JOB DESCRIPTION

At Memorial Hermann, we pursue a common goal of delivering high quality, efficient care while creating exceptional experiences for every member of our community. When we say every member of our community, that includes our employees. We know that when our employees feel cared for, heard and valued, they are inspired to create moments that exceed expectations, while prioritizing safety, compassion, personalization and efficiency. If you want to advance your career and contribute to our vision of creating healthier communities, now and for generations to come, we want you to be a part of our team.

Job Summary

Under general supervision, the Credentialing Specialist will be responsible for conducting activities related to initial credentialing, re-credentialing, delegation, facility credentialing and ongoing provider file maintenance. Typically reports to the Credentialing Manager.

Job Description

Minimum Qualifications

Education: Associate's degree preferred.

Licenses/Certifications: (None)

Experience / Knowledge / Skills:

• One (1) year of Credentialing experience in a managed care plan, Medical Staff Services, or credentialing verification office.

• Effective analytical skills with the ability to assess compliance, record, analyze, and interpret data into meaningful formats.

• Effective oral and written communication skills.

• Basic computer skills: Microsoft Office, Word and Excel.

• Basic understanding of credentialing Joint Commission, NCQA, and URAC accreditation standards.

• Demonstrated ability to work both independently and collaboratively with a team and with multiple departments while being able to take full responsibility for tasks.

Principal Accountabilities

• Processes provider applications and re-applications including initial mailing, review and loading. Also coordinates the distribution of emails, mail outs or other documents to customers.

• Assists in the implementation of procedures and activities related to the credentialing, re-credentialing and privileging of network providers.

• Maintains provider profiling system and communicates with providers by phone and mail regarding credentialing status.

• Tracks, maintains and updates licensure: DEA and state narcotics certification or other expiring credentials. Coordinates with physician office to obtain expiring documents.

• Answers internal and external customer phone calls. Provide physicians with credentialing application status updates in a timely and professional manner. Escalate customer concerns appropriately.

• Monitors physician sanction sources and board actions. Escalates alerts appropriately.

• Performs basic data entry on credentialing applications.

• Ensures safe care to patients, staff and visitors; adheres to all Memorial Hermann policies, procedures, and standards within budgetary specifications including time management, supply management, productivity and quality of service.

• Promotes individual professional growth and development by meeting requirements for mandatory/continuing education and skills competency; supports department-based goals which contribute to the success of the organization; serves as preceptor, mentor and resource to less experienced staff.

• Demonstrates commitment to caring for every member of our community by creating compassionate and personalized experiences. Models Memorial Hermann’s service standards by providing safe, caring, personalized and efficient experiences to patients and colleagues.

• Other duties as assigned.