Credentialing Specialist - The Health Plan

 
Position: Credentialing Specialist - The Health Plan

Job ID: 160319

Location: US-TX-Houston

Department: CREDENTIALING MANAGEMENT

Talent Area: Administrative Support

Full/Part Time: Full-Time

Regular/Temporary: Regular

Shift: 8a - 5p Monday - Friday

About Texas Children's Hospital

Founded in 1996, Texas Children’s Health Plan is the nation's first health maintenance organization (HMO) created just for children. We provide STAR/Medicaid and Children's Health Insurance Program (CHIP) to pregnant women, teens, children and adults in Houston and surrounding areas. Currently, the Health Plan has more than 375,000 members who receive care from our network of more than 1,100 primary care physicians, 3,200 specialists, and 70 hospitals. Texas Children's Health Plan is also the largest combined STAR/CHIP Managed Care Organization in the Harris County service area.   To join our community of 14,000+ dedicated team members, visit texaschildrenspeople.org for career opportunities. You can also learn more about our amazing culture at infinitepassion.org.   Texas Children’s is proud to be an equal opportunity employer. All applicants and employees are considered and evaluated for positions at Texas Children's without regard to mental or physical disability, race, color, religion, gender, national origin, age, genetic information, military or veteran status, sexual orientation, gender identity, marital status or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.

Summary:

We are searching for a Credentialing Specialist -- someone who works well in a fast-paced setting. In this position, you will develop and maintain positive relationships with physicians, providers, and practice while leading the credentialing process. This position is responsible for managing and completing government enrollment, credentialing of managed care network providers (practitioners and institutions), and oversight of delegation of credentialing to provider groups

 

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Responsibilities :

Job Duties & Responsibilities

  • Facilitates receipt of necessary documents from providers and reviews for accuracy
  • Identifies and communicates government payer trends and significant provider issues to management in a timely manner
  • Provide ongoing support to providers regarding credentialing and on-boarding
  • Develops and maintains a satisfactory business relationship with departments and providers
  • Identifies educational needs within the provider groups and initiates educational efforts as needed or upon request
  • Coordinates all aspects of credentialing following NCQA and TDI requirements
  • Liaisons with provider groups, office managers and providers regarding managed care credentialing applications, statuses, and missing information
  • Submits required reports, ad hoc reports, and completed projects to management in a timely manner
  • Completes assigned projects in accordance within completion dates that are determined by manager. These may include audits of government applications, provider effective dates with identification of areas of delay


Qualifications:

Being fully vaccinated against COVID-19 is required for all employees at Texas Children’s, unless approved for a medical or religious exemption

 

Skills & Requirements

  • Being fully vaccinated against COVID-19 is required for all employees unless approved for a medical or religious exemption
  • High school diploma or GED required
  • Associate’s degree or some college preferred
  • Bachelor’s degree in business administration, health education or related field may substitute for four years of the health care administration, managed care, or customer service experience
  • CPMSM and CPCS certification preferred
  • 4 years health care administration, managed care, or customer service experience required


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