Senior Credentialing Specialist - The Health Plan

 
Position: Senior Credentialing Specialist - The Health Plan

Job ID: 149470

Location: US-TX-Bellaire

Department: CREDENTIALING MANAGEMENT

Talent Area: Administrative Support

Full/Part Time: Full-Time

Regular/Temporary: Regular

Shift: 8a-5p Monday-Friday

About Texas Children's Hospital

The Texas Children’s Hospital system is the largest pediatric integrated care system and is an industry leader in pediatric population health. Founded in 1996, Texas Children’s Health Plan is the nation's first health maintenance organization (HMO) created just for children and pregnant women.  We are an Integrated Community System providing holistic care that empowers families to live healthier lives.  Texas Children's Health Plan is also the largest combined STAR/CHIP Managed Care Organization in the Harris County service area.  Currently, the Health Plan serves more than 450,000 members across three state territories (Harris, Jefferson, North East), who receive care from our network of more than 1,100 primary care physicians, 3,200 specialists, and 70 hospitals. To join our community of 13,000 dedicated team members, visit www.texaschildrenspeople.org for career opportunities. You can also learn more about our amazing culture at www.infinitepassion.org.

Summary:

We are searching for a Senior Credentialing Specialist – someone who works well in a fast-paced setting. In this position, you’ll develop and maintain positive relationships with physicians, providers, and practice managers while leading the credentialing process. You will manage and complete government enrollment, credentialing of our managed care network providers, and oversee the delegation of credentialing to provider groups.

 

Think you’ve got what it takes?



Responsibilities :

 • Lead the reappointment or initial credentialing process, monitor work queues, and process status measures, which can include developing work flows and file structure, conducting meetings to ensure progress, resolving problems, and deploying interventions to improve efficiency
• Train new employees, validate competency, and provide continuous education to physicians and other staff
• Serve as a resource for staff to clarify policies, procedures, and accreditation standards
• Facilitate peer review of credentialing files, audit performance, and monitor staff professionalism and customer response
• Complete, track, and confirm Medicaid, Medicare, and CSHCN applications with status updates and weekly reports
• Facilitate receipt of necessary documents from providers and review for accuracy
• Identify and communicate government payor trends and significant provider issues to management in a timely manner
• Assist providers with paperwork and schedule credentialing application review/training as needed
• Liaise with provider groups, office managers, and providers in regards to managed care credentialing applications, status, and missing information
• Submit progress reports to management on a weekly basis
• Complete assigned projects as determined by the manager (audits of government applications, etc.)



Qualifications:

High school diploma or GED (associate’s degree or some college preferred)
• 4 years’ experience in health care administration, managed care, or customer service
• CPMSM and CPCS certification desired
• Bachelor’s degree in business administration, health education, or related field may substitute for four years of health care administration, managed care, or customer service experience



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