Credentialing Specialist I

HCA Healthcare•Houston, TX

16d•Remote

About The Position

The Credentialing Specialist supports the development and implementation of Credentialing Processing Center policies, procedures, processes, and documentation. The role handles credentialing for new and established healthcare providers, maintains credentialing information and files, and performs primary source verification, follow-up, data collection and entry, and document review. The specialist supports selected HCA hospitals and works in compliance with CPC policies and procedures and applicable federal and state regulations and accreditation standards. The position also assists the Manager and Director with other assigned tasks and projects. The schedule is Monday through Friday, 9:30 a.m. to 6:00 p.m. CST. Remote employees must live within 60 miles of an HCA hospital and have wired cable or fiber internet with at least 25 Mbps download and 15 Mbps upload.

Requirements

Associate degree or an equivalent combination of education and experience.
Completion of post-Cactus/Symplr training testing with a score of 85% or greater.
Understanding of professional telephone etiquette.
Ability to work with minimal supervision and effectively in both individual and group environments.
Remote employees must live within 60 miles of an HCA hospital.
Remote employees must have wired cable or fiber internet with at least 25 Mbps download and 15 Mbps upload.

Nice To Haves

Bachelor’s degree preferred.
At least one year of healthcare credentialing experience preferred, such as in a healthcare facility, managed care setting, credentials verification organization, or Medical Staff Office.
Experience with credentialing accreditation by The Joint Commission or the National Committee for Quality Assurance preferred.
Working knowledge of the healthcare and credentialing industry, including medical-legal issues and laws, regulatory agencies, and national standards preferred.
NAMSS certification at the CPCS level preferred, or commitment to pursue certification within one year.

Responsibilities

Assist with planning, developing, implementing, and documenting processes during migration.
Assist in establishing, reviewing, and implementing quality controls and reviews during migration.
Provide input on process design and other implementation activities.
Manually enter practitioner data and perform primary source verification of selected items.
Maintain high-quality, timely, and accurate credentialing processes for medical and allied healthcare professionals in accordance with CPC policies and procedures.
Enter, log, and scan information into the credentialing system for initial, updated, and add-on applications and maintenance processes.
Act as a liaison and point person with the MSO to ensure required information is completed and delivered to clients on time.
Process and maintain credentialing and recredentialing in accordance with CPC policies and procedures, Joint Commission standards, and state and federal regulations.
Ensure credential files are current and complete, including information on medical licenses, board certifications, professional liability insurance, DEA credentials, and other pertinent items.
Monitor received information, follow up on missing items or incomplete forms, and request follow-up verifications as needed.
Identify and evaluate potential red flags and collaborate with practitioners to document the issue and physician response.
Advise the Manager and/or Director of questionable information and issues identified during credentialing processes.
Submit closed files for audit or final review and obtain missing items identified in the review.
Maintain credential files and accurately file correspondence related to credentialing and reappointment; stay current on processes and legal and regulatory requirements.

Benefits

Medical, prescription drug, dental, vision, behavioral health, and telemedicine coverage.
Wellbeing support, including free counseling and referral services.
Paid time off and paid family leave.
Long- and short-term disability coverage and leaves of absence.
401(k) plan with a 100% match on 3% to 9% of pay, based on years of service.
Employee Stock Purchase Plan and flexible spending accounts.
Preferred banking partnerships, retirement readiness tools, rollover support, and financial wellbeing counseling.
Tuition assistance, student loan assistance, certification support, dependent scholarships, and a partnership with Galen College of Nursing.
Fertility and family-building benefits and adoption assistance.
Life insurance and supplemental health protection plans.
Auto and home insurance, legal counseling, identity theft protection, and consumer discounts.