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SalaryWe are searching for a Credentialing Specialist - someone who works well in a fast-paced managed care setting. In this position, you'll process credentialing and re-credentialing files obtaining primary source verification and maintaining credentialing databases.
Think you've got what it takes?
Requirements:
- High school diploma
- A minimum of three (3) years of managed care or health care experience
- Knowledge of the credentialing process and NCQA, JCAHO, state and federal HMO regulations is required for completely satisfactory performance in this job
- Group process and problem solving is helpful
Job Duties & Responsibilities:
- Reviews materials as provided by the Credentialing Coordinator to maintain a working knowledge of the credentialing steps required by regulations or accrediting bodies
- Reviews and understands the internal policies & procedures for performing credentialing and
- re-credentialing primary source verification and file and report preparations for committee
- Maintains a primary credentialing database reflecting all in network providers and a database to track status of practitioner's or facilities undergoing the direct credentialing or re-credentialing process
- Establishes individual files for each applicant containing the application, documents to support primary source verification and any other communications
- Contacts providers to request updates to licenses and documents with expiration dates
- Continuously updates the database(s) with the most current information
- Files supplied documentation in each individual practitioner or facility file
- Data enter information supplied by delegated credentialing entities and create reports for committee
- Prepares for outside audits of the Credentialing ProgramFounded in 1996, Texas Children's Health Plan is the nation's first health maintenance organization (HMO) created just for children. We provide STAR/Medicaid and Children's Health Insurance Program (CHIP) to pregnant women, teens, children and adults in Houston and surrounding areas. Currently, the Health Plan has more than 375,000 members who receive care from our network of more than 1,100 primary care physicians, 3,200 specialists, and 70 hospitals. Texas Children's Health Plan is also the largest combined STAR/CHIP Managed Care Organization in the Harris County service area.
To join our community of 14,000+ dedicated team members, visit texaschildrenspeople.org for career opportunities. You can also learn more about our amazing culture at infinitepassion.org.
Texas Children's is proud to be an equal opportunity employer. All applicants and employees are considered and evaluated for positions at Texas Children's without regard to mental or physical disability, race, color, religion, gender, national origin, age, genetic information, military or veteran status, sexual orientation, gender identity, marital status or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.
