Sr. Credentialing Specialist – The Health Plan - **Full Remote**

Position: Sr. Credentialing Specialist – The Health Plan - **Full Remote**

Location: US-TX-Houston

Talent Area: Administrative Support

Shift: 8am - 5pm

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 for career opportunities. You can also learn more about our amazing culture at  At Texas Children’s Hospital, diversity, equity, and inclusion are at the core of our values and mission for all of the patients and families that we serve. We are committed to providing a diverse and inclusive work environment for all faculty, staff and learners throughout our organization. We believe that each member of our one amazing team provides enrichment that allows us to create a lasting legacy for future employees of this great organization.   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.


We are searching for a — someone who works well in a fast-paced setting. In this position, you will develop and maintain positive relationships with physicians, providers, and practice managers within the TCHP network while leading the credentialing process. Position interacts with physicians, directors, managers, and peers on a daily basis. You'll be responsible for managing and completing government enrollment, credentialing of TCHP managed care network providers (practitioners and institutions), and oversight of delegation of credentialing to provider groups. You’ll provide guidance, training, and mentorship of other staff in the performance of their responsibilities while overseeing efficient and timely functioning of operational processes.

Think you’ve got what it takes?

Responsibilities :

Job Duties & Responsibilities

  • Lead the reappointment or initial credentialing process and monitoring work queues and process status measures
  • Develop workflows and file structure. Conducts meetings to ensure workload progress, resolve problems and deploy interventions to improve efficiency and maximize timeliness
  • Train new employees, validates competency, and provides continuous education to physicians and other staff
  • Provide support and employee development through constructive feedback and mentoring
  • Serve as resource for staff to clarify policies, procedures, and accreditation and regulatory standards
  • Facilitates peer review of credentialing files, audits performance, and monitors staff professionalism and customer response
  • Answer questions from departments contacts related to the process of provider credentialing or on-boarding
  • Identify educational needs within the provider groups and initiates educational efforts as needed or upon request
  • Maintain system of documentation for internal and external communication
  • Ensure managed care credentialing applications (practitioners and institutions) are completed and reviewed within TCHP guidelines
  • Liaison with provider groups, office managers and providers regarding managed care credentialing applications, statuses and missing information
  • Educate provider group credentialing managers, office managers and providers regarding NCQA and TDI requirements for credentialing
  • Document and responds to provider issues as appropriate
  • Submit progress reports to management on a weekly basis. Weekly reports are utilized to create the monthly report of timeliness of credentialing report


Skills & Requirements

  • Being fully vaccinated against COVID-19, including any booster dose(s) of the COVID-19 vaccine recommended by the Centers for Disease Control when eligible, is required for all employees at Texas Children’s, unless approved for a medical or religious exemption.
  • High School Diploma Or GED Required
  • Associate's Degree Or Some College Preferred
  • CPMSM - Cert-cert PROF Med Servic Mgmt And CPCS - Cert-provid Credential SPCLST Preferred
  • 6 Years Health Care Administration, Managed Care, Or Customer Service Experience Required

**This position has been approved for full remote work for in and out of state candidates.  Certain exclusions may apply**

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