Credentialing Specialist

About us

TECQ Partners is a small business in Houston, TX. We are innovative, customer-centric, data-driven and our goal is to improve our members health while decreasing the administrative burden and cost of healthcare.

Our work environment includes:

• Wellness programs
• On-the-job training
• Relaxed atmosphere

Position summary:

Under the direction of the Manager of Credentialing, the Credentialing Specialist will organize, maintain, and verify all aspects of the credentialing process, and maintain current files on practitioners, including track the expiration of certifications to maintain up to date files and assist the organization’s practitioner’s and customers with inquiries. The position will serve as the primary liaison to contracted providers and internal departments.

The Credentialing Specialist will make certain the accuracy of all information and will be reliable, energetic and have excellent people skills.

Essential functions:

• Responsible for timely processing initial credentialing and re-credentialing applications for individual practitioners and facility providers, including conducting primary source verification of the applicant’s information as required by federal, state and/or accrediting regulatory organizations
• Monitor and assist further investigations as deemed necessary during the credentialing process by document evaluation, primary source verifications, or as requested by TECQ Credentials Committee and/or Credentials Committee Chair
• Prepare initial credentialing and re-credentialing files for the Medical Director and/or the Credentials Committee.
• Works closely with Provider Contracting and Provider Relations to ensure the credentialing application process is efficient and meets established turnaround times.
• Responsible for expirable tracking to ensure all licensing, professional liability, and verifications are current at the time of Committee decision.
• Attend monthly Credentialing Committee meetings, and act on the decisions of the Committee.
• Record query results of primary source verifications and maintain confidential credentialing files and electronic credentialing database
• Review query results of ongoing monitoring reports and report adverse findings as applicable
• Ensure accuracy of provider data in the credentialing and claims databases, including appropriate provider contractual affiliations
• Participate in the development and implementation of departmental policies, procedures, forms, etc.
• Conduct internal delegated credentialing audits and assist with the coordination of external delegated credentialing audits
• Respond to credentialing inquiries via the departmental mailbox
• Perform sanction primary source verifications within prescribed time limits for internal audits
• Other duties as assigned

Experience:

• 2+ years credentialing experience in a managed care setting highly preferred, one year required.
• Experience with credentialing software programs such as MDStaff, Symplr (Cactus) or similar programs is preferred.

Qualifications:

• High school diploma, GED, or suitable equivalent required. College degree preferred.
• NAMSS Certification as a Certified Professional Medical Services Manager (CPMSM) or Certified Provider Credentials Specialist (CPCS) highly preferred.
• Knowledge of medical credentialing and privileging procedures and standards of the National Committee for Quality Assurance (NCQA).
• Excellent verbal and written communication skills.
• Proficient with Microsoft Office Word and Excel.
• Proficient touch-typing skills.
• Ability to focus for extended periods.

This position, along with team members within assigned units and across the organization, fosters an engaging and professional environment committed to respect, inclusivity, continuous improvement, and teamwork.

The position works within policies and procedures, related to the department and organization, and supports efforts needed for organizational growth, proposal developments, fiscal management, and monitoring, reporting and analysis, and support compliance with local, state, and federal regulations as well as regulatory, controlling, and licensing agencies.

TECQ Partners provides equal access to and opportunity in its organization and employment, without regard to race, color, creed, religion, national origin, gender, age, marital status, disability, public assistance status, veteran status, sexual orientation, gender identity, or gender expression.

Job Type: Full-time

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Health insurance
• Paid time off
• Vision insurance

Schedule:

• Day shift
• Monday to Friday

Work Location: In person