Credentialing Specialist The Health Plan - **Full Remote**

About Texas Children's Hospital

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

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

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