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GMG Health Systems is Hiring a Credentialing Specialist Near San Antonio, TX
General Summary: The Credentialing Specialist is responsible for managing and maintaining the credentialing data for our healthcare providers in the credentialing database, ensuring accuracy and compliance with regulatory requirements. This role will be involved in all aspects of the initial credentialing, re-credentialing, and privileging with area hospitals, health plans, and patient care facilities. They are also responsible for timely renewal of licensures, certifications and appropriate routing of all credentialing documents, and has the ability to collaborate with internal and external stakeholders.
Supervisory Responsibilities: This position has no supervisory responsibilities.
General Requirements: All duties performed will be done accurately and in a timely manner.
- This position may require driving a company vehicle or a personal vehicle; therefore, employees must successfully complete a motor vehicle history check, possess, and maintain a current valid Texas Driver License, and proof of current insurance to be subject for mileage reimbursement.
- Provide training and support to internal teams and providers on credentialing processes, requirements, and best practices.
- Stay abreast of emerging trends and technologies in credentialing data management, recommending and implementing enhancements to improve efficiency and accuracy.
- Stay informed about industry best practices, regulatory changes, and accreditation requirements related to provider credentialing, ensuring compliance and recommending process improvements.
- Collaborate with the IT team to optimize and enhance the credentialing data management systems and processes.
- Participate in internal and external audits and inspections related to provider credentialing, health plan delegation requests, providing accurate data and documentation as needed.
Essential Job Responsibilities:
- Manage the credentialing data for all healthcare providers, including maintaining accurate and up-to-date provider information, credentials, and certifications.
- Ensure timely and accurate data collection, entry, and verification of provider credentials, including licenses, certifications, education, training, and professional affiliations.
- Conduct thorough and detailed provider credentialing and re-credentialing processes, ensuring compliance with regulatory requirements and organizational policies.
- Collaborate with internal teams, such as provider relations, human resources, contracting, and quality assurance, to obtain and validate provider data and documentation.
- Review and analyze provider applications, ensuring completeness and accuracy of information, and follow up with providers to obtain missing or additional documentation as needed.
- Conduct thorough background checks and verification of provider credentials through primary sources, such as licensing boards, educational institutions, and professional organizations.
- Maintain accurate and up-to-date provider credentialing files and databases, ensuring confidentiality and adherence to all applicable privacy and compliance regulations.
- Monitor and track provider expirable, such as licenses, certifications, and malpractice insurance, and initiate timely renewal processes to ensure uninterrupted provider participation.
- Collaborate with the provider relations team to communicate credentialing status updates to providers, resolving any credentialing-related inquiries or concerns.
- Assist in the preparation of provider credentialing reports, audits, and presentations for internal and external stakeholders.
- Strong organizational and time management skills, with the ability to manage multiple priorities and meet deadlines.
- Excellent communication and interpersonal skills, with the ability to collaborate with internal teams and external stakeholders.
- Strong problem-solving and critical-thinking skills, with the ability to identify and resolve credentialing-related issues.
- High ethical standards and a commitment to maintaining confidentiality and integrity.
- Demonstrated ability to work independently and collaboratively with cross-functional teams.
- Exceptional customer service skills, with the ability to build and maintain positive relationships with internal and external stakeholders.
Education and Training: Minimum high school education or equivalent. Bachelor's degree in Healthcare Administration, Business, or a related field preferred. Relevant experience may be considered in lieu of a degree.
Certified Provider Credentialing Specialist (CPCS) or Certified Professional Medical Services Management (CPMSM) certification a plus.
Experience: Minimum of 2-3 years of experience in provider credentialing or a related role within the healthcare industry.
Strong organizational and time management skills, with the ability to manage multiple priorities and meet deadlines.
Excellent communication and interpersonal skills, with the ability to collaborate with internal teams and external stakeholders.
Strong problem-solving and critical-thinking skills, with the ability to identify and resolve credentialing-related issues.
Other Requirements: Computer Skills: Proficiency in Microsoft Office Suite, particularly Excel, for data analysis and reporting. Strong knowledge of credentialing processes, regulatory requirements, and accreditation standards, such as NCQA, CMS, and The Joint Commission. Proficiency in using credentialing software and databases. Fast learners would be considered.
Work Environment: Clinic environment. Exposure to communicable diseases, bodily fluids, toxic substances, ionizing radiation, medicinal preparations, and other conditions common to a clinic environment.
Mental / Physical Requirements: Requires manual dexterity, sitting, standing, stooping, reaching, kneeling, crouching, bending, walking, lifting up to 20 lbs. Close vision and ability to adjust focus. Must be able to work efficiently under pressure.
Additional Information: Gonzaba Medical Group is seeking team members who contribute as A-Players, demonstrate a strong work ethic, are committed to the culture and our core values.
Other Duties As Assigned: The above job description is not intended to be an all-inclusive list of duties and standards of the position. Team members will follow any other instructions, and perform any other related duties, as assigned by their supervisor. Responsibilities, knowledge, skills, abilities, and work environments may change as needs evolve.
Experience
Preferred- 2 - 3 years: Minimum of 2-3 years of experience in provider credentialing or a related role within the healthcare industry.
Education
Preferred- Bachelors or better in Business Administration or related field
Job Summary
Full Time
$42k-52k (estimate)
05/09/2024
07/07/2024
The job skills required for Credentialing Specialist include Customer Service, Patient Care, Confidentiality, Microsoft Office, Problem Solving, Time Management, etc. Having related job skills and expertise will give you an advantage when applying to be a Credentialing Specialist. That makes you unique and can impact how much salary you can get paid. Below are job openings related to skills required by Credentialing Specialist. Select any job title you are interested in and start to search job requirements.
The following is the career advancement route for Credentialing Specialist positions, which can be used as a reference in future career path planning. As a Credentialing Specialist, it can be promoted into senior positions as a Compliance Manager - Healthcare that are expected to handle more key tasks, people in this role will get a higher salary paid than an ordinary Credentialing Specialist. You can explore the career advancement for a Credentialing Specialist below and select your interested title to get hiring information.
If you are interested in becoming a Credentialing Specialist, you need to understand the job requirements and the detailed related responsibilities. Of course, a good educational background and an applicable major will also help in job hunting. Below are some tips on how to become a Credentialing Specialist for your reference.
Step 1: Understand the job description and responsibilities of an Accountant.
Quotes from people on Credentialing Specialist job description and responsibilities
A certified professional credentialing specialist ensures that staff members of a facility maintain licenses, training, and certifications based on federal and state law.
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A credentialing specialist can have certificates that will prove useful to their field.
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Credentialing specialists also ensure that any services provided by medical facilities meet the required standards as set by state and federal government agencies.
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Credentialing specialists are part of an organization's administrative staff; they review medical policies, process contracts, and facilitate audit reports to validate that certified medical professionals comply with credentialing procedures.
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Credentialing specialists will also ensure that their employer meets state, federal and other regulations for quality of care.
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Step 2: Knowing the best tips for becoming an Accountant can help you explore the needs of the position and prepare for the job-related knowledge well ahead of time.
Career tips from people on Credentialing Specialist jobs
Credentialing specialists can often find work with a high school diploma or the equivalent.
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Some employers strongly prefer credentialing specialists who have a Certified Provider Credentialing Specialist (CPCS) credential.
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While an associate degree may not be required for a position as a credentialing specialist, some employers may prefer applicants with a two-year degree.
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Make Use Of Advanced Software For Monitoring.
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Stay Updated with the Coalition for Affordable Quality Healthcare's Credentialing Program.
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Step 3: View the best colleges and universities for Credentialing Specialist.
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