Credentialing Specialist - The Health Plan

Summary
We 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

• Group process and problem solving is helpful
• Being fully vaccinated against COVID-19, including any booster dose(s) of the COVID-19 vaccine recommended by the Centers for Disease Control when eligible, is required for all employees at Texas Children’s, unless approved for a medical or religious exemption.
• 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
• High school diploma

Job Duties & Responsibilities

• 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
• Continuously updates the database(s) with the most current information
• Files supplied documentation in each individual practitioner or facility file
• Reviews materials as provided by the Credentialing Coordinator to maintain a working knowledge of the credentialing steps required by regulations or accrediting bodies
• Re-credentialing primary source verification and file and report preparations for committee
• Reviews and understands the internal policies & procedures for performing credentialing and
• Prepares for outside audits of the Credentialing Program
• Contacts providers to request updates to licenses and documents with expiration dates
• Establishes individual files for each applicant containing the application, documents to support primary source verification and any other communications
• Data enter information supplied by delegated credentialing entities and create reports for committee