Credentialing Coordinator

Methodist Health System•Dallas, TX

2d•Onsite

About The Position

Dallas Methodist Physicians Network (DMPN) is an Independent Practitioner Association (IPA) affiliated with Methodist Health System (MHS). Practitioners affiliated with MHS participate in DMPN’s managed care plans. DMPN also handles the credentialing for the MHS Accountable Care Organization (ACO). This role provides Human Resources support to new employees during the on-boarding process to include scheduling pre-employment physicals, new hire paperwork, benefits and the coordination of orientation and necessary computer training. Work with MHS Employee Health to coordinate the completion of follow-up pre-employment requirements. Pre-screen applicants as part of the recruitment process. Prepare new hire folders. Initiate the background check process on prospective applicants. Assist with scheduling interviews. Assist in keeping employee files updated.

Requirements

Some college or college degree preferred but not required.
Certified Provider Credentialing Specialist (CPCS) preferred but not required.
Experience in using Windows and various software applications including MD Staff, Excel Word and Outlook.
Multitasking skills.
Knowledge of the most current credentialing forms required by CMS, TMHP and TDI.
Skill in using computer and calculator.
Ability to examine documents for accuracy and completeness.
Ability to prepare applications in accordance with detailed instructions.
Skill in defining problems and necessary collecting data.
Ability to work effectively with physicians and co-workers.
Ability to communicate clearly, both verbally and written.
High School Diploma or GED.
Minimum One year of credentialing and working with health plans.
Proficient computer skills with a strong emphasis with MS Excel.

Nice To Haves

Some college or college degree preferred but not required.
Certified Provider Credentialing Specialist (CPCS) preferred but not required.

Responsibilities

Demonstrates knowledge of DMPN’s Credentialing Plan and Guidelines; ongoing monitoring; credentialing standards for NCQA, URAC, CMS, TDI including Texas Administrative Codes pertaining to credentialing.
Responsible for inputting credentialing data, maintaining the accuracy and completeness of the fields in MD Staff for all participating practitioners and for building customized reports in MD Staff.
Responsible for gathering credentialing/recredentialing documents and information; performs primary source verification of credentialing information; reviews and analyzes the documentation for completeness and accuracy; investigates any red flags/issues; follows up on applications that are incomplete.
Prepares completed files for review and approval by the Credentialing Committee or Chair.
Responsible for setting up electronic credentialing file for each practitioner and saving credentialing documents into practitioners’ electronic files.
Responsible for tracking, obtaining and reviewing current expirables for practitioners.
Assists in preparing for annual delegated credentialing health plan audits
Other duties as assigned.
Ability to multitask with minimal errors and utilize critical thinking skills.
Must be able to maintain the confidentiality of data.
Must be detail oriented, organized, self-starter, and have an ability to prioritize workload.
Ability to analyze and interpret data and solve practical problems in independent and team environments.
Ability to work under deadlines and manage multiple projects while completing work in an accurate and timely manner.
Strong verbal and written communication skills.
Responsible for data integrity, accuracy, and consistency.
Interacts with physicians and practice administrators to secure required information.
Supports the mission, vision, values and strategic goals of Methodist Health System.
Adheres to DMPN’s procedures and guidelines.
Adheres to MHS’s procedures and guidelines.
Provide Human Resources support to new employees during the on-boarding process to include scheduling pre-employment physicals, new hire paperwork, benefits and the coordination of orientation and necessary computer training.
Work with MHS Employee Health to coordinate the completion of follow-up pre-employment requirements.
Pre-screen applicants as part of the recruitment process.
Prepare new hire folders.
Initiate the background check process on prospective applicants.
Assist with scheduling interviews.
Assist in keeping employee files updated.