Credentialing Specialist - Kelsey-Seybold Clinics - Pearland, TX
About The Position
Explore opportunities with Kelsey-Seybold Clinic, part of the Optum family of businesses. Work with one of the nation’s leading health care organizations and build your career at one of our 40+ locations throughout Houston. Be part of a team that is nationally recognized for delivering coordinated and accountable care. As a multi-specialty clinic, we offer care from more than 900 medical providers in 65 medical specialties. Take on a rewarding opportunity to help drive higher quality, higher patient satisfaction and lower total costs. Join us and discover the meaning behind Caring. Connecting. Growing together. The Credentialing Specialist will be responsible for the credentialing and recredentialing of all employed Kelsey-Seybold physicians and contracted affiliated providers. The functions include but are not limited to initial and recredentialing applications, mailing and tracking of all applications, primary source verifications, file production and maintenance, presentation at Credentialing Committee, internal and external communication of outcome reporting, liaison with designated payors regarding the delegation of credentialing/recredentialing to Kelsey-Seybold (initial assessments, onsite audits, corrective action plans and submission of monthly reports), hospital privileges, assist with credentialing subdelegations and tracking of licensure/certification expirations You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
Requirements
- High school diploma or equivalent
- 2+ years of Credentialing experience with hospital application experience or managed care experience
- Proficient: Microsoft Access, Word and Excel
- Capable of sitting for extended periods of time
Nice To Haves
- College Degree
- Certification
- Knowledge of AAAHC, NCQA and TDI credentialing standards
- Knowledge of MD Staff
- Academic Credentialing or Coordinator experience
- Proven self starter who can work independently with minimal supervision
Responsibilities
- Credentialing and recredentialing of all employed Kelsey-Seybold physicians and contracted affiliated providers.
- Processing initial and recredentialing applications.
- Mailing and tracking of all applications.
- Performing primary source verifications.
- File production and maintenance.
- Presenting at Credentialing Committee.
- Communicating outcomes internally and externally.
- Liaising with designated payors regarding the delegation of credentialing/recredentialing to Kelsey-Seybold (initial assessments, onsite audits, corrective action plans and submission of monthly reports).
- Managing hospital privileges.
- Assisting with credentialing subdelegations.
- Tracking of licensure/certification expirations.
Benefits
- Comprehensive benefits package
- Incentive and recognition programs
- Equity stock purchase
- 401k contribution
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
