Provider, Facility and Ancillary credentialing, to include all aspects of new applicant credentialing, re-credentialing; ongoing maintenance of provider credentials; online verifications; administrative support of credentialing functions.
Reports To: Manager, Credentialing
Position Location: Houston, TX 77081
Additional Responsibilities: Candidate Education:
- Review new applications and supporting documents in a virtual environment and apply policy and criteria required for credentialing processing.
- Perform all required primary source verifications.
- Contact hospitals, licensing agencies, malpractice carriers, and medical schools to obtain credentialing verifications.
- Maintain and update credentialing database records.
- Review malpractice history, regulatory and disciplinary action reports issued by state and federal agencies invoking appropriate processes as defined in policies and procedures.
- Review the CAQH system and download applications or supplemental documents as appropriate.
- Maintain electronic provider files.
- Perform outreach to providers and facilities via phone calls and fax/email correspondence.
- Demonstrate knowledge of credentialing regulatory and accreditation requirements (NCQA, CMS, Medicaid, etc.).
- Perform other duties as assigned.
- Required A High School or GED
- Required 2 years of experience in a customer service or healthcare related position
- Preferred 1 year of experience in Credentialing
Licenses and Certifications:
- Intermediate Demonstrated written communication skills
- Intermediate Demonstrated interpersonal/verbal communication skills
- Intermediate Ability to work as part of a team
- Intermediate Ability to effectively present information and respond to questions from peers and management
- Intermediate Other Knowledge of credentialing software sufficient to develop appropriate reports on all aspects of credentialing
A license in one of the following is required:
- Preferred Other Certified provider credentialing specialist or directly related or equivalent work experience
- Required Intermediate Microsoft Word
- Required Intermediate Microsoft Excel
- Required Intermediate Microsoft Outlook
- Required Intermediate Other Ability to learn various software packages as may be necessary to perform job functions