Managed Care Credentialing Coordinator

Texas Scottish Rite for Children•Dallas, TX

6d•Hybrid

About The Position

Our patients are our number one priority! We're committed to giving children back their childhood! This role is responsible for assisting leadership in the development, planning, implementation, review, and revision of managed care credentialing processes, forms, and related policies and procedures. The coordinator will maintain a working knowledge of health plan practices, and accrediting and regulatory agency requirements (i.e., NCQA), keeping the medical staff updated on all changes. This position facilitates, coordinates, prepares, monitors, maintains, and implements all credentialing functions for medical staff and advanced practice professionals in a timely manner, including managed care credentialing applications for network participation and re-credentialing with health plans. The role involves ensuring all expirables (licensures, certifications, specialty certifications, malpractice insurance) are reviewed, obtained, maintained, and managed prior to expiration, notifying appropriate leadership staff of upcoming expirations. The coordinator will originate or collect, update, and maintain all required documentation and records in managed care medical staff credentialing software databases. Regular monitoring of payer websites for accuracy of provider information and addressing deficiencies with payers is also a key responsibility. The role includes developing annual goals for the Managed Care Credentialing function, maintaining knowledge of relevant laws and regulations, supporting the General Counsel with legal matters and special projects, and providing professional support to management staff. The position also involves attending meetings, taking minutes, and assisting with miscellaneous duties and special projects.

Requirements

High school diploma or equivalent required
Minimum 2 years of Medical Staff or Managed Care Credentialing Coordinator experience; in a 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

Associate 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 upon hire is preferred. Otherwise, certification must be obtained within 1 year of hire or 1year of eligibility per NAMSS requirements, as applicable

Responsibilities

Assist 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., NCQA); maintain a working knowledge of such documents and keeps the medical staff updated on all changes
Facilitate, coordinate, prepare, monitor, maintain and implement 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
Ensure 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; notify appropriate medical and administrative leadership staff prior to expiration so that required documents can be secured and updated or required intervention or actions can be accomplished in a timely manner
Originate or collect, update and maintain: all required documentation and records and the managed care medical staff credentialing software databases as appropriate
Maintain reporting and communication with hospital leadership as to credentialing status of hospital, physician staff, and advanced practice professionals
Regularly monitor payer websites to ensure accuracy of Scottish Rite for Children and providers in payer online tools (i.e., provider manuals); address with payer to correct any deficiencies
Develop annual goals and objectives for the Managed Care Credentialing function in concert with the organization’s strategic plan
Develop, maintain, and apply working knowledge of relevant federal and state laws and regulations and accreditation standards/agencies and other regulatory requirements (i.e., NCQA)
Support the General Counsel in handling of legal matters for Scottish Rite, assist with special projects and help maintain files in the Office of General Counsel
Provide professional support to the management staff in partnership with other support staff
Attend meetings and take minutes for these meetings as requested
Assist with miscellaneous duties and special projects as assigned