HP Credentialing - CME Spec

DRISCOLL HEALTH PLAN•Corpus Christi, TX

1d•Onsite

About The Position

Where compassion meets innovation and technology and our employees are family. Thank you for your interest in joining our team! Please review the job information below. Essential Duties and Responsibilities: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions. This job description is not intended to be all-inclusive; employees will perform other reasonably related business duties as assigned by the immediate supervisor and/or health plan administration as required. Maintains utmost level of confidentiality at all times. Adheres to DHS/DHP policies and procedures. Demonstrates business practices and personal actions that are ethical and adhere to corporate compliance and integrity guidelines. Processes applications for credentialing and recredentialing. Processes requests for temporary privileges. Prepares confidential correspondence. Oversees and maintains the credentialing database program. Maintains all credentials files. Prepares credentialing profiles. Monitors database for expiration of required credentials, securing current verification of licensure, DEA, and professional liability insurance. Monitors state and federal sanctions reports. Oversight of all provider data to be published in provider directories and GeoAccess prepared provider maps. Other duties as needed to support business operations. Education and/or Experience: High school diploma or general education degree (GED); or three to five years related experience and/or training; or equivalent combination of education and experience. Credentialing and/or Health Plan/HMO experience is preferred. Until all children are well. Driscoll Children’s Hospital and its specialty centers, urgent care centers, and after-hours facility serve a vast area covering 31 South Texas counties. The hospital is a 191-bed tertiary care center offering 32 medical and 13 surgical specialties. Combined with our non-profit, community-based Health Plan, Driscoll Health System is an exceptional workplace for anyone with a big heart and a drive for success. Smiles, hugs and a soothing touch are as much a part of Driscoll’s approach to treating children as is its advanced medical treatments and technologies. The core values at Driscoll Heath System are: Compassion, Advocacy, Respect, Excellence, and Stewardship. These values are exemplified through every position - from treating the most critical patients hands-on, to maintaining a clean environment, to keeping the organization running from behind the scenes. We invite you to learn about Driscoll’s rich history and explore the laidback lifestyle South Texas has to offer.

Requirements

High school diploma or general education degree (GED); or three to five years related experience and/or training; or equivalent combination of education and experience.

Nice To Haves

Credentialing and/or Health Plan/HMO experience is preferred.

Responsibilities

Maintains utmost level of confidentiality at all times.
Adheres to DHS/DHP policies and procedures.
Demonstrates business practices and personal actions that are ethical and adhere to corporate compliance and integrity guidelines.
Processes applications for credentialing and recredentialing.
Processes requests for temporary privileges.
Prepares confidential correspondence.
Oversees and maintains the credentialing database program.
Maintains all credentials files.
Prepares credentialing profiles.
Monitors database for expiration of required credentials, securing current verification of licensure, DEA, and professional liability insurance.
Monitors state and federal sanctions reports.
Oversight of all provider data to be published in provider directories and GeoAccess prepared provider maps.
Other duties as needed to support business operations.