Senior Credentialing Specialist

Memorial Hermann Houston , TX 77020

Posted 3 weeks ago

At Memorial Hermann, we're about creating exceptional experiences for both our patients and our employees. Our goal is to provide opportunities for our diverse employee population that develop and grow careers in a team-oriented environment focused on patient care.

Every employee, at every level, begins their journey at Memorial Hermann learning about the history of the organization and its established culture built on trust and integrity. Our employees drive this culture, and we want you to be a part of it.

Job Summary

The Senior Credentialing Specialist is responsible for the coordination of all activities associated with the credentialing and re-credentialing of physicians and providers. The position will be responsible in ensuring that credentialing policies and procedures meet all organizational, state regulatory and external accreditation requirements. This position reports to the Manager of Credentialing.

Job Description

Minimum Qualifications

Education: High School Diploma or GED; Associates degree preferred

Licenses/Certifications: (None)

Experience / Knowledge /

  • 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 on initial credentialing and re-credentialing practices for medical professionals including primary source verification methods, and compliance monitoring

  • Demonstrates commitment to the Partners-in-Caring process by integrating our culture in all internal and external customer interactions; delivers on our brand promise of "we advance health" through innovation, accountability, empowerment, collaboration, compassion and results while ensuring One Memorial Hermann.

Principal Accountabilities

  • Under general direction, implements and monitors procedures and activities related to the credentialing, re-credentialing and privileging of network providers.

  • Processes provider applications and re-applications including initial mailing, review, and loading of database into system ensuring high quality standards are maintained.

  • 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 processes, 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 including time management, supply management, productivity and quality of service.

  • 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.

  • Other duties as assigned.

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Senior Credentialing Specialist

Memorial Hermann