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Houston, Texas, United States
Onsite
At Memorial Hermann, we pursue a common goal of delivering high quality, efficient care while creating exceptional experiences for every member of our community. When we say every member of our community, that includes our employees. We know that when our employees feel cared for, heard and valued, they are inspired to create moments that exceed expectations, while prioritizing safety, compassion, personalization and efficiency. If you want to advance your career and contribute to our vision of creating healthier communities, now and for generations to come, we want you to be a part of our team.
Job Summary
Responsible for front-line coordination of the system-wide credentialing function, including the accurate and timely processing of provider applications either through initial review or re-application process. Is specifically responsible for daily workflow throughput, routing of the credentialing applications for processing, and meeting management.Minimum Qualifications
Education: Associates degree in Medical Staff Services or related field; in lieu of a degree the equivalent combination of education, training, and experience.
Licenses/Certifications: Current Certified Practitioner Credentialing Specialist (CPCS) preferred. Certified Professional Medical Services Management (CPMSM) designation preferred.
Experience / Knowledge / Skills:
Five (5) to eight (8) years credentialing in a Managed Care Plan, Medical Staff Services, or Credentialing verification office; or up to three (3) years experience in a health care setting, including two (2) years of practitioner enrollment, credentialing or provider network management experience.
Experience with credentialing software systems, such as MSOW, Echo, or Cactus.
Expert knowledge of initial credentialing and re-credentialing practices for medical professionals including primary source verification methods, and compliance monitoring.
Experience with accrediting bodies such as TJC, NCQA, URAC, CMS, HEDIS, TDI, OR DNV.
Experience with management of referral providers.
Demonstrated ability to work independently.
Ability to manage multiple projects efficiently and accurately.
Strong analytical skills needed to assess compliance, record, analyze and interpret data into meaningful formats.
Ability to communicate effectively and professionally with practitioners, administrators, external stakeholders and all levels of staff.
Advanced Medical Terminology knowledge.
Expert knowledge of Microsoft Office, Word and Excel.
Principal Accountabilities
Coordinates daily workflow of the department and credentialing work products, including routing of the credentialing applications (payor and provider).
Prepares information for audit requirements, as requested by the department director.
Prepares for and attends Credentials, Medical Executive Committee, and Governing Board meetings.
Oversees new and existing employee training related to enterprise-wide Credentialing tools and technologies, including system upgrades.
Onboard new employees to the department and system-wide Credentialing processes, in alignment with standard operating procedures of the department.
Coordinates special projects related to system-wide Credentialing activities.
Assists billing department as necessary for claims resolution.
Serves to resolve tier 1 issues/complaints re: Credentialing with providers; escalates as necessary to the department manager.
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.
Demonstrates commitment to caring for every member of our community by creating compassionate and personalized experiences. Models Memorial Hermann’s service standards by providing safe, caring, personalized and efficient experiences to patients and colleagues.
Other duties as assigned.
