Quality Audit Credentialing Specialist II

HCA Healthcare•Houston, TX

1d•Remote

About The Position

The Credentialing Processing Center Specialist II safeguards patient well-being and supports clinical excellence by ensuring hospitals and other healthcare facilities have comprehensive, verified credentials for practitioners. The role supports informed decisions about practitioner access and works with more than 350 healthcare facilities, customers, and stakeholders. The specialist performs detailed credentialing reviews, identifies and escalates practitioner risks and compliance concerns, and ensures credentialing is accurate and completed on time. The role handles complex and sensitive documentation, coordinates follow-up for missing or incomplete information, documents resolved and unresolved issues, maintains secure credentialing records, contributes to policy development and audits, and advises managers and directors on ambiguous information and critical issues. The candidate must live within 60 miles of an HCA facility in FL, GA, ID, KS, KY, MO, NC, NH, NV, SC, TN, TX, UT, or VA. Remote employees must have wired cable or fiber internet with at least 25 Mbps download and 15 Mbps upload.

Requirements

Associate’s degree or equivalent work experience.
At least 5 years of experience in healthcare credentialing with Parallon or HCA.
Must live within 60 miles of an HCA facility in FL, GA, ID, KS, KY, MO, NC, NH, NV, SC, TN, TX, UT, or VA.
Remote employees must have wired cable or fiber internet access with at least 25 Mbps download and 15 Mbps upload.

Nice To Haves

Bachelor’s degree.
Experience with credentialing accreditation by The Joint Commission or the National Committee for Quality Assurance.
Detailed working knowledge of the healthcare and credentialing industry, including medical-legal issues and laws, regulatory agencies, and national standards.
NAMSS certification.

Responsibilities

Ensure practitioner credentials are comprehensive, verified, and legally required for hospital and healthcare facility access.
Collaborate with healthcare facilities, practitioners, external organizations, customers, and other stakeholders.
Conduct and apply Data Integrity Reviews, Specialist Reviews, and Compliance Reviews to identify potential practitioner issues and risks.
Follow regulatory guidelines, Joint Commission Standards, facility bylaws, and Credentialing Processing Center standards.
Complete credentialing of medical and allied healthcare providers accurately and within required timeframes.
Identify, validate, and escalate practitioner risk concerns, including concerns that may fall outside policy requirements.
Collect required information and follow up on missing or incomplete documentation through effective communication.
Work with practitioners and external organizations to document or resolve sensitive and confidential compliance issues.
Document the resolution or status of complex issues and escalations in practitioner files.
Contribute insight to policy development and implementation and participate in audits to support regulatory adherence.
Provide counsel to managers and directors regarding ambiguous information and promptly escalate critical issues.
Maintain accurate credentialing records and ensure correspondence is scanned and securely stored within mandated timeframes.
Comply with applicable policies, procedures, and federal and state regulatory and accrediting agency requirements.

Benefits

Medical, prescription drug, dental, vision, behavioral health, and telemedicine coverage.
Free counseling and referral services.
Paid time off, paid family leave, 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.