Centralized Credentialing Specialist - Abercrombie

 
Position: Centralized Credentialing Specialist - Abercrombie

Location: US-TX-Houston

Talent Area: Clinical Support

Shift: 8a - 5p (M-F)

About Texas Children's Hospital

Since 1954, Texas Children’s has been leading the charge in patient care, education and research to accelerate health care for children and women around the world. When you love what you do, it truly shows in the smiles of our patient families, employees and our numerous accolades such as being consistently ranked as the best children’s hospital in Texas, and among the top in the nation by U.S.News & World Report as well as recognition from Houston Business Journal as one of this city’s Best Places to Work for ten consecutive years.   Texas Children’s comprehensive health care network includes our primary hospital in the Texas Medical Center with expertise in over 40 pediatric subspecialties; the Jan and Dan Duncan Neurological Research Institute (NRI); the Feigin Center for pediatric research; Texas Children’s Pavilion for Women, a comprehensive obstetrics/gynecology facility focusing on high-risk births; Texas Children’s Hospital West Campus, a community hospital in suburban West Houston; and Texas Children’s Hospital The Woodlands, the first hospital devoted to children’s care for communities north of Houston. We have also created the nation’s first HMO for children, established the largest pediatric primary care network in the country and a global health program that is channeling care to children and women all over the world. Texas Children’s Hospital is also academically affiliated with Baylor College of Medicine, one of the largest, most diverse and successful pediatric programs in the nation.   To join our community of 14,000+ dedicated team members, visit texaschildrenspeople.org for career opportunities. You can also learn more about our amazing culture at infinitepassion.org.   Texas Children’s is proud to be an equal opportunity employer. All applicants and employees are considered and evaluated for positions at Texas Children's without regard to mental or physical disability, race, color, religion, gender, national origin, age, genetic information, military or veteran status, sexual orientation, gender identity, marital status or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.    

Summary:

We are searching for a Centralized Credentialing Specialist – someone who works well in a fast-paced setting. In this position, you’ll be responsible for managing and completing all credentialing functions related to the Provider On-Boarding process for staff members. This role will primarily be responsible for ensuring providers presented to the Texas Children’s Credentials Committee, TCPSO Credentials Committee, and Texas Children’s Executive Vice President are highest quality in accordance to Texas Children’s Hospital Bylaws and Mission, Joint Commission (JC) standards and National Council of Quality Assurance (NCQA) guidelines.

 

Think you’ve got what it takes?



Responsibilities :

Job Duties & Responsibilities

 

  • Determines applicant’s eligibility for membership/participation with Texas Children’s Medical Staff and Texas Children’s Physician Services Organization (TCPSO)
  • Analyzes application and supporting documents for adherence to Joint Commission (JC), National Council for Quality Assurance (NCQA), regulatory standards, and managed care delegated agreements
  • Recognizes, investigates, and validates discrepancies and adverse information obtained from the application, primary source verifications, or other identified sources to ensure that review and approval bodies have the information needed to make informed credentialing decisions
  • Compiles, evaluates, and presents the practitioner-specific data collected and assembled during the verification process for review to the approving Section Chief, Department in Chief, Texas Children’s Credentials Committee and TCPSO Credentials Committee
  • Ensures compliance with Texas Children’s Hospital Bylaws, credentialing policies, government regulations, and accreditation and regulatory standards
  • Conducts and participates in audits of credentialing entities to ensure compliance with accreditation and regulatory standards by completing pre-audits on requested provider files
  • Obtains and evaluates practitioner sanctions utilizing the National Practitioners Data Bank (NPDB), complaints received from managed care payors, and adverse data received from multiple accrediting and government entities
  • Participates in the development, implementation, and ongoing assessment of service plans, delineation of privileges, rules and regulations, and policies and procedures to ensure continuous compliance with accreditation and regulatory standards
  • Provides education for on-boarding providers and key stakeholders
  • Provides reporting on provider credentialing, reappointments, and various other reports as requested
  • Communicates effectively and appropriately represents the provider, facility, and physician group
  • Assures that monthly and quarterly communications and reports from the Texas Children’s Hospital Board of Directors and TCPSO Credentials Committee are completed
  • Resolves medical and departmental staff with resolution of system access, claim denials, participation status, and/or urgent patient care access issues

 



Qualifications:

Skills & Requirements

 

  • High School Diploma or GED is required
  • Bachelor’s degree in Business, Finance, Healthcare Administration, or Accounting is preferred
  • Certified Provider Credentialing Specialist (CPCS) is preferred
  • Provider Enrollment Specialist Certificate (PESC) is preferred
  • 4 years of experience in a physician practice, physician billing, hospital or managed health care setting is required
  • 1 year of experience with presentations, summary reports, and/or committee participation is preferred


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