Managed Care Credentialing Specialist - (Museum District)

Houston Methodist • Houston, TX

415d

About The Position

The Managed Care Credentialing Specialist at Houston Methodist is responsible for the timely and accurate completion and submission of credentialing documents for new physicians and advanced practice practitioners. This role involves consistent interaction with providers, administrators, and health plans, ensuring compliance with regulations and maintaining high standards of quality and service in the credentialing process.

Requirements

• High School diploma or equivalent education.
• Three years experience with physician credentialing and/or other medical administrative-related tasks.
• Demonstrated skills and competencies necessary to perform the assigned job.
• Sufficient proficiency in speaking, reading, and writing the English language.
• Ability to effectively communicate with patients, physicians, family members, and co-workers.
• Self-motivated with excellent organizational skills.
• Ability to manage multiple priorities and projects.
• Detail-oriented with a desire for producing work with 100% accuracy.
• Intermediate level of computer competency - Microsoft Office Suite.

Nice To Haves

• CPMSM - Certified Professional Medical Services Management (NAMSS)
• CPCS - Certified Provider Credentialing Specialist (NAMSS)

Responsibilities

• Provide information to physicians and advanced practice practitioners on necessary requirements for credentialing documents.
• Educate on-boarding providers and key stakeholders.
• Respond to inquiries regarding the provider's application and information internally and externally.
• Process and maintain credentialing and re-credentialing documents in the appropriate software system.
• Submit all necessary documents to governmental and commercial plans on a timely basis.
• Provide regular and ad hoc reports regarding the status of credentialing documents.
• Investigate and validate discrepancies and adverse information from applications and verifications.
• Ensure compliance with government regulations and organizational standards.
• Perform annual audits of provider files in preparation for re-credentialing.
• Provide information to the Central Business Office and Managed Care department regarding claims requiring additional information.

What This Job Offers

• Job Type: Full-time
• Industry: Nursing and Residential Care Facilities
• Education Level: High school or GED