Credentialing Specialist

Job Description

Job Description

We are seeking a detail-oriented and highly organized Credentialing Specialist to join our team in Houston, TX for a contract to hire opportunity. The Credentialing Specialist will ensure the accuracy, completeness, and compliance of credentialing processes for medical providers. This critical role facilitates provider credentialing with precision and adheres to federal, state, and organizational procedures while maintaining confidentiality and professionalism. This role is an excellent opportunity for individuals with a strong background in medical credentialing, excellent organizational skills, and the ability to manage sensitive data effectively. Apply today to become part of our team and contribute to maintaining the high standards of healthcare compliance!

Duties and Responsibilities:

1. Application Review: Assess and screen initial and reappointment credentialing applications for compliance with regulations and organizational policies.
2. Verification: Conduct primary source document verification; collect and validate credentials, resolving discrepancies as needed.
3. Issue Resolution: Identify and address gaps or errors in information that may impact credentialing, escalating issues to relevant teams for resolution.
4. Records Monitoring: Maintain complete and accurate credentialing files, ensuring documentation complies with quality standards and accreditation requirements.
5. Database Management: Enter and update provider data in the credentialing database, ensuring accuracy and adapting data as required.
6. Tracking and Follow-Up: Track and manage credentialing processes, including follow-ups for verification and timely application processing.
7. Process Improvements: Assist in developing and implementing system-wide improvements for credentialing processes.
8. Reporting and Compliance: Generate reports required by regulatory and accrediting bodies to ensure compliance with policies and standards.
9. Communication: Communicate effectively with providers, medical staff leadership, and administrators, addressing credentialing and privileging concerns as they arise.
10. Professional Development: Pursue ongoing professional growth through workshops, seminars, and affiliations to stay updated on healthcare regulations and legislation.
11. Additional Duties: Perform miscellaneous assigned job-related tasks as needed.

Knowledge, Skills, and Abilities Required:

• Communication Skills: Proficient oral and written communication abilities.
• Customer Service: Excellent customer service skills with the ability to address inquiries tactfully and efficiently.
• Email Management: Capable of responding to emails promptly and effectively.
• Research Skills: Competence in researching and gathering information.
• Credentialing Knowledge: Strong understanding of medical provider credentialing procedures, principles, policies, and documentation.
• Healthcare Knowledge: Familiarity with clinical or hospital operations and procedures.
• Judgment & Discretion: Ability to exercise independent judgment in handling confidential information with discretion.
• Administrative Decisions: Ability to make sound procedural decisions and judgments.
• Technical Skills: Advanced knowledge of Microsoft Word and Excel, with the ability to learn and adapt to new applications.
• Organizational Skills: Skilled in prioritizing tasks and independently managing day-to-day responsibilities.
• Database Management: Proficiency in computerized spreadsheet creation and database management.