Senior Credentialing Specialist

3 weeks ago

Houston, Texas, United States Memorial Hermann Health System Full time

At Memorial Hermann, we strive to deliver exceptional care and create personalized experiences for every member of our community.

We believe that when our employees feel valued, heard, and supported, they are inspired to create moments that exceed expectations, while prioritizing safety, compassion, and efficiency.

If you want to advance your career and contribute to our vision of creating healthier communities, we invite you to explore this opportunity.

Job Summary

The Senior Credentialing Specialist is responsible for coordinating all activities associated with the credentialing and re-credentialing of physicians and providers.

This role ensures that credentialing policies and procedures meet all organizational, state regulatory, and external accreditation requirements.

This position reports to the Manager of Credentialing.

Job Description

Key Responsibilities

  • Processes provider applications and re-applications, including initial mailing, review, and loading of database into system, ensuring high quality standards are maintained.
  • Leads training initiatives for less experienced specialists, participates in proctoring credentialing exams, and conducts regular file audits.
  • Maintains provider profiling system and communicates with providers by phone and mail regarding credentialing status.
  • May provide guidance or expertise to less experienced specialists.
  • Serves as a liaison during the credentialing process, communicating with providers regarding credentialing status and information in a timely manner.
  • Assists in managing policies and procedures relating to credentialing and provider delegation maintenance.
  • Ensures safe care to patients, staff, and visitors; adheres to all Memorial Hermann policies, procedures, and standards within budgetary specifications.
  • 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.

Requirements

  • Associates degree preferred.
  • Three (3) years of Credentialing experience in a managed care plan, Medical Staff Services, or credentialing verification office.
  • Strong analytical skills with the ability to assess compliance, record, analyze, and interpret data into meaningful formats.
  • Effective oral and written communication skills.
  • Basic computer skills: Microsoft Office, Word, and Excel.
  • Proficient understanding of credentialing Joint Commission, NCQA, and URAC accreditation standards.
  • Demonstrated understanding of initial credentialing and re-credentialing practices for medical professionals, including primary source verification methods, and compliance monitoring.

Working at Memorial Hermann

We are committed to creating a work environment that is inclusive, supportive, and empowering. We believe that our employees are our greatest asset, and we strive to provide opportunities for growth, development, and recognition.

As a member of our team, you will have access to a range of benefits, including competitive compensation, comprehensive health insurance, and opportunities for professional development.

We are an equal opportunity employer and welcome applications from diverse candidates.

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