Credentialing Coordinator (Temporary Contract)

Texas Scottish Rite for Children•Dallas, TX

3d•Hybrid

About The Position

Our patients are our number one priority! We're committed to giving children back their childhood! Job Posting Title: Credentialing Coordinator (Temporary Contract) Location: Dallas - Hospital Additional Posting Details: Monday - Thursday, 7:00am - 4:30pm; Friday, 8:00am - 12:00pm Hybrid schedule Job Description: Duties/Responsibilities Assists hospital and medical staff leadership in the development, planning, implementation, review and revision of managed care credentialing processes, forms, related policies and procedures with regard to credentialing to stay current with Health Plans practice as well as accrediting and regulatory agency requirements (i.e. The Joint Commission). Maintains a working knowledge of such documents and keeps the medical staff updated on all changes. Takes a lead role in Facilitates, coordinates, prepares, monitors, maintains and implements all of the credentialing functions for medical staff and advanced practice professionals, in a timely manner, such as: managed care credentialing applications for network participation re-credentialing with health plans, monitoring, including procurement of applications and required supporting documents. Ensures all expirables are reviewed, obtained, maintained and managed by tracking, documenting: licensures, certifications, specialty certification, and malpractice insurance information prior to their expiration dates and other expirables as required. Notifies appropriate medical and administrative leadership staff prior to expiration so that required documents can be secured and updated. Notifies appropriate medical and administrative leadership staff prior to expiration so that required intervention or actions can be accomplished in a timely manner. Originates or collects, updates and maintains: all required documentation and records and the managed care medical staff credentialing software databases as appropriate Assists with delegation rosters, follow-up and confirmation of loads with Payors Maintains reporting and communication with Hospital leadership as to credentialing status of hospital, physician staff, and advanced practice professionals. Regularly monitors payer websites to ensure accuracy of TSRHC Hospital and providers in payer online tools (i.e. provider manuals). Address with payer to correct any deficiencies. Develop, maintain and apply working knowledge of relevant federal and state laws and regulations and accreditation standards/agencies and other regulatory requirements (i.e. TJC) Interact with the office of General Counsel in handling of credentialing matters for the Hospital Provides professional support to the management staff in partnership with other support staff May be requested at attend meetings and take minutes for these meetings Will assist with miscellaneous duties and special projects as assigned

Requirements

High School Diploma Required
3-5 Years of Medical Staff or Managed Care Credentialing experience; hospital, clinic or health plan setting is preferred
Proficient in computer applications (e.g. Windows, Microsoft Office, Internet browsers, medical staff/credentialing software databases, etc.)
Knowledge of standards in managed care credentialing practiced, health plan credentialing requirements, statistics, data collection, analysis and data presentation
Excellent interpersonal communication, organizational and problem-solving skills.

Nice To Haves

Bachelor’s Degree Preferred
Certification through the National Association of Medical Staff Services (NAMSS) as a Certified Provider Credentialing Specialist (CPCS) or Certified Professional Medical Staff Management (CPMSM) is preferred.

Responsibilities

Assists hospital and medical staff leadership in the development, planning, implementation, review and revision of managed care credentialing processes, forms, related policies and procedures with regard to credentialing to stay current with Health Plans practice as well as accrediting and regulatory agency requirements (i.e. The Joint Commission).
Maintains a working knowledge of such documents and keeps the medical staff updated on all changes.
Takes a lead role in Facilitates, coordinates, prepares, monitors, maintains and implements all of the credentialing functions for medical staff and advanced practice professionals, in a timely manner, such as: managed care credentialing applications for network participation re-credentialing with health plans, monitoring, including procurement of applications and required supporting documents.
Ensures all expirables are reviewed, obtained, maintained and managed by tracking, documenting: licensures, certifications, specialty certification, and malpractice insurance information prior to their expiration dates and other expirables as required.
Notifies appropriate medical and administrative leadership staff prior to expiration so that required documents can be secured and updated.
Notifies appropriate medical and administrative leadership staff prior to expiration so that required intervention or actions can be accomplished in a timely manner.
Originates or collects, updates and maintains: all required documentation and records and the managed care medical staff credentialing software databases as appropriate
Assists with delegation rosters, follow-up and confirmation of loads with Payors
Maintains reporting and communication with Hospital leadership as to credentialing status of hospital, physician staff, and advanced practice professionals.
Regularly monitors payer websites to ensure accuracy of TSRHC Hospital and providers in payer online tools (i.e. provider manuals).
Address with payer to correct any deficiencies.
Develop, maintain and apply working knowledge of relevant federal and state laws and regulations and accreditation standards/agencies and other regulatory requirements (i.e. TJC)
Interact with the office of General Counsel in handling of credentialing matters for the Hospital
Provides professional support to the management staff in partnership with other support staff
May be requested at attend meetings and take minutes for these meetings
Will assist with miscellaneous duties and special projects as assigned