Centralized Credentialing Specialist

We’re searching for a Centralized Credentialing Specialist, someone who works well in a fast-paced setting. In this position you will be the single point of contact and responsible for managing and completing all credentialing functions related to the Provider On-Boarding process for members of the Medical Staff and the Physician Services Organization. Responsible for ensuring providers presented to the Credentials Committee and Executive Vice President are highest quality in accordance with Bylaws and Mission, Joint Commission (JC) standards and National Council of Quality Assurance (NCQA) guidelines.

Think you’ve got what it takes?

Job Duties & Responsibilities
•    Determines applicant’s eligibility for membership/participation with Medical Staff & Physician Services Organization.
•    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, and Credentials Committee.  
•    Creates summary of findings, prepare verification documentation, and notify Legal Counsel, Section Chief and Credentials Committee Chair within 24 hours of red flag identification. 
•    When temporary privileges are requested, analyzes application and determines if the applicant meets the minimum requirements; notifies Executive Vice President, provides provider details, and requests approval.
•    Regularly obtains, evaluates and communicates to provider and departmental leadership licensure information from primary sources. Suspends privileges and membership within 24 hours of non-compliance as documented in Bylaws, Rules & Regulations and Credentialing policies.
•    Initiates provider access and training to all applicable systems and resources.
•    When Urgent/One Time privileges are requested, responsible for immediate review, analysis of application and communication of immediate patient care needs to the Credentials Committee Chair, Service physician leadership and Executive Vice President; Submits all provider access requests and follow up with approving departments, including internal leadership.
•    Ensures compliance with Bylaws, credentialing policies, government regulations, and 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.
•    Effectively communicates and appropriately represents the provider, facility, and physician group.

Skills & Requirements
•    High School Diploma or GED required
•    Bachelor's Degree Business, Finance, Healthcare Administration or Accounting preferred
•    CPMSM - Cert-Cert PROF Med Servic Mgmt preferred
•    A Provider Enrollment Specialist Certificate (PESC) from DecisionHealth preferred
•    4 year's Experience in a physician practice, physician billing, hospital or managed health care setting required
•    1-year Presentations, summary reports, and/or committee participation preferred 
•    A bachelor's degree in finance, Accounting, Business or Healthcare Administration may substitute for 2 years of experience. An associate's degree may substitute for 1 year of experience.
 

About Texas Children’s

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 Tower 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; Texas Children’s Hospital The Woodlands, the first hospital devoted to children’s care for communities north of Houston; and Texas Children’s Hospital North Austin, the new state-of-the-art facility providing world-class pediatric and maternal care to Austin and Central Texas families. We have also created Texas Children’s Health Plan, the nation’s first HMO focused on children; Texas Children’s Pediatrics, the largest pediatric primary care network in the country; Texas Children’s Urgent Care clinics that specialize in after-hours care tailored specifically for children; and a global health program that is channeling care to children and women all over the world. Texas Children’s Hospital is affiliated with Baylor College of Medicine, one of the largest, most diverse and successful pediatric programs in the nation. 

 To join our community of 15,000+ dedicated team members, visit texaschildrenspeople.org for career opportunities.

 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.