Supp. Credentialing Coordinator

Memorial Hermann Health System•West, TX

14d

About The Position

At Memorial Hermann, we pursue a common goal of delivering high quality, efficient care while creating exceptional experiences for every member of our community. When we say every member of our community, that includes our employees. We know that when our employees feel cared for, heard and valued, they are inspired to create moments that exceed expectations, while prioritizing safety, compassion, personalization and efficiency. If you want to advance your career and contribute to our vision of creating healthier communities, now and for generations to come, we want you to be a part of our team. Job Summary The Credentialing Coordinator is responsible for the coordination of all activities associated with the credentialing and re-credentialing of physicians and providers. The position will be responsible in ensuring that credentialing policies and procedures meet all organizational, state regulatory and external accreditation requirements.

Requirements

Associates degree in related field; in lieu of associate’s degree a minimum of four (4) years of relevant experience in the healthcare, managed care or insurance industry.
Four (4) years of database management or medical staff coordination in managed care environment and/or health insurance experience or a minimum of two (2) years of hospital or managed care credentialing.
Knowledgeable and compliant with all relevant laws, rules regulations and accreditation standards and requirement.
Demonstrated understanding on initial credentialing and re-credentialing practices for medical professionals including primary source verification methods, and compliance monitoring.
Effective oral and written communication skills.
Intermediate proficiency in Microsoft Office software: Word and Excel.

Nice To Haves

Current, unrestricted Certified Professional Credentialing Specialist (CPCS) preferred.
Knowledge of basic Health Care, Managed Care principles and medical terminology preferred.
Understanding of credentialing Joint Commission, NCQA, and URAC accreditation standards.

Responsibilities

Implements and monitors procedures and activities related to the credentialing, re-credentialing and privileging of network providers according to plan specifications.
Processes provider applications and re-applications including initial mailing, review, and loading of database into system ensuring high quality standards are maintained.
Maintains practitioner credentialing and organizational/facility provider assessment files and credentialing databases including adds/changes and terminations.
Communicates with providers by phone and mail regarding credentialing status and information in a timely manner.
Facilitates the on-boarding of new providers.
Ensures compliance with credentialing, delegation, monitoring and oversight requirements of any relevant accreditation, regulatory and other oversight entities.
Assists in managing policies and procedures relating to credentialing and provider delegation maintenance.
Conducts delegation audits of delegated entities as applicable.
Provides feedback to reduce errors and improve processes and performance.
Communicates, collaborates and cooperates with internal and external stakeholders.
Adheres to all Compliance/Program Integrity requirements.
Complies with HIPAA regulations.
Ensures safe care to patients, staff and visitors; adheres to all Memorial Hermann policies, procedures, and standards within budgetary specifications including time management, supply management, productivity and quality of service.
Promotes individual professional growth and development by meeting requirements for mandatory/continuing education and skills competency; supports department-based goals which contribute to the success of the organization; serves as preceptor, mentor and resource to less experienced staff.
Demonstrates commitment to caring for every member of our community by creating compassionate and personalized experiences.
Models Memorial Hermann’s service standards by providing safe, caring, personalized and efficient experiences to patients and colleagues.
Other duties as assigned.