Managed Care Credentialing Specialist - (Museum District)

Houston Methodist • Houston, TX

157d

About The Position

At Houston Methodist, the Managed Care Credentialing Specialist position is responsible for the timely and accurate completion and submission of managed care credentialing documents for new physicians and advanced practice practitioners (APPs). Duties for this position include credentialing and enrollment in governmental and commercial managed care plans and medicare and medicaid. The Managed Care Credentialing Specialist position has consistent interaction with the new providers, Administrators, health plans (commercial and governmental), and the department.

Requirements

• High School diploma or equivalent education (examples include: GED, verification of homeschool equivalency, partial or full completion of post-secondary education, etc.)
• Three years experience with physician credentialing and/or other medical administrative-related tasks.

Responsibilities

• Provides information to physicians and advanced practice practitioners on necessary requirements for all credentialing documents.
• Provides education for on-boarding providers and key stakeholders.
• Responds to inquiries regarding the provider's application and information internally and externally.
• Processes and maintains credentialing and re-credentialing documents into the appropriate software system by entering, logging and scanning information.
• Submits all necessary documents to governmental and commercial plans on a timely basis.
• Provides regular and ad hoc reports regarding status of credentialing documents.
• Recognizes, investigates, and validates discrepancies and adverse information obtained from the application, primary source verifications, or other identified sources.
• Ensures compliance with government regulations and organizational standards and requirements.
• Performs audit of provider files annually in preparation for re-credentialing of current providers.
• Provides the Central Business Office and Managed Care department information when claims from commercial and governmental plans require additional information or clarification regarding credentialing.
• Ensures managed care plans receive documentation timely promptly when completed so providers can commence patient care timely.
• Manages the databases continually and improves reporting and filtering capability to enable better business functions.
• Reviews software and database systems to report any discrepancies or data entry issues.
• Seeks opportunities to identify self-development needs and takes appropriate action.

What This Job Offers

• Education Level: High school or GED
• Number of Employees: 5,001-10,000 employees