Position Summary:

This position is responsible for supporting and coordinating all provider and physician credentialing activities. The Credentialing Coordinator verifies that all policies and procedures associated with credentialing meets external accreditation, state regulatory requirements, and organizational requirements.

Position Key Accountabilities:

1. Conducts credentialing and re-credentialing related activities.
2. Monitors and maintains credentialing databases and files for practitioners and providers.
3. Facilitates applications and re-applications for providers per company and state requirements.
4. Communicates with providers in a timely manner regarding status of credentialing via written or verbal communication.
5. Maintains additions, changes, and terminations in credentialing database.
6. May facilitate new provider orientation and onboarding.
7. May manage policies and procedures associated with provider credentialing.
8. Conducts credentialing audits and satisfaction surveys.
9. Effectively communicates with all stakeholders.
10. Continuous compliance with HIPPA regulations and Compliance/Program Integrity requirements.
11. Performs other duties as assigned.

Certification/Skills:

Certified Professional Credentialing Specialist (CPCS) preferred
Current and thorough knowledge of all rules, laws, regulations, accreditation requirements and standards relevant to credentialing. Knowledgeable of NCQA, URAC, and Joint Commission standards and requirements of accreditation. Proficiency (intermediate) with MS Office software, Word, Excel. Demonstrated effective written and oral communication skills.

Minimum Education:

Associates Degree in related field or equivalent experience in lieu of degree.

Minimum Experience:

Three (3) years of credentialing, database management, or medical staff coordination in managed care environment.

Physical Requirements:

Exerts up to 20 pounds of force occasionally and/or up to 10 pounds frequently and/or a negligible amount constantly to move objects.

Security Sensitive:

This job class may contain positions that are security sensitive and thereby subject to the provisions of Texas Education Code § 51.215

Residency Requirement:

Employees must permanently reside and work in the State of Texas.