Credentialing Specialist

3 weeks ago


Huntsville, Texas, United States Huntsville Memorial Hospital Full time

Job Summary

The Credentialing Specialist at Huntsville Memorial Hospital is responsible for credentialing, reappointment processing, and maintenance of files for medical staff members. This role involves coordinating with the Director of Medical Staff Services and the Director of Revenue Cycle to ensure compliance with regulatory standards and hospital policies.

Key Responsibilities

  • Process applications and credentials for medical staff applicants, allied health applicants, and locum tenens applicants.
  • Assist in the reappointment process for all medical staff categories.
  • Coordinate monthly physician on-call calendars and maintain a permanent record of on-call calendars.
  • Distribute meeting calendars to department managers and active medical staff members.
  • Prepare agenda, information packets, and coordinate arrangements for the Credentials Committee.
  • Maintain confidential files on all medical staff members, reflecting current status, privileges, attendance records, CME activities, publications, and committee participation.
  • Maintain records, files, policies, and procedures as required by Joint Commission Standards.
  • Assist in preparation for CIHQ Survey working closely with the Medical Staff to ensure compliance with standards.
  • Apply for and renew annually all provider licenses, professional, DEA, and controlled substance.
  • Complete revalidation requests issued by government payers.
  • Complete credentialing applications to add providers to commercial payers, Medicare, and Medicaid.
  • Maintain accurate provider profiles on CAQH, PECOS, NPPES, and CMS databases.

Requirements

  • High school diploma or GED required.
  • 3-5 years hospital payer credentialing/payer enrollment experience preferred.
  • CPCS or CPMSM certification preferred.
  • Excellent interpersonal, problem-solving, and written and oral communication skills.


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