Payer & Enrollment Credentialing Specialist (Hybrid)

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

MUST BE LOCAL TO HOUSTON OR SURROUNDING AREAS.

HYBRID SCHEDULE: 40-hour work (8 hour days)
1 week in office & 1 remote (rotating schedule)

HIGHLY PREFERRED:
- Advanced knowledge in payer enrollment, dealing with enrollment for Medicare & Medicaid
- Knowledge in CAQH (also known as Data Spring), CMS, TMHP enrollment, - Medicare enrollment, and PECOS portal)


The Senior Credentialing Specialist is responsible for the coordination of all activities associated with the credentialing and re-credentialing of physicians and providers. The position will be responsible in ensuring that credentialing policies and procedures meet all organizational, state regulatory and external accreditation requirements. This position reports to the Manager of Credentialing.

Job Description

Minimum Qualifications

Education: Associates degree preferred

Licenses/Certifications: (None)

Experience / Knowledge / Skills:

• Three (3) years of Credentialing experience in a managed care plan, Medical Staff Services, or credentialing verification office

• Strong analytical skills with the ability to assess compliance, record, analyze, and interpret data into meaningful formats

• Effective oral and written communication skills

• Basic computer skills: Microsoft Office, Word and Excel

• Proficient understanding of credentialing Joint Commission, NCQA, and URAC accreditation standards

• Demonstrated understanding on initial credentialing and re-credentialing practices for medical professionals including primary source verification methods, and compliance monitoring

Principal Accountabilities

• Under general direction, implements and monitors procedures and activities related to the credentialing, re-credentialing and privileging of network providers.

• Processes provider applications and re-applications including initial mailing, review, and loading of database into system ensuring high quality standards are maintained.

• Leads training initiatives for less experienced specialists, participates in proctoring credentialing exams, and conducts regular file audits.

• Maintains provider profiling system and communicates with providers by phone and mail regarding credentialing status.

• May provide guidance or expertise to less experienced specialists.

• Serves as a liaison during the credentialing processes, communicating with providers regarding credentialing status and information in a timely manner.

• Assists in managing policies and procedures relating to credentialing and provider delegation maintenance.

• 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.