Credentialing Specialist III at QTC Management, Inc. in Houston, Texas

Job Description:

Do you crave a career that truly makes an impact in people’s lives?  Do you thrive on problem-solving and finding solutions? Join a dedicated, tight-knit team that creates an immediate and meaningful impact every day.

Leidos QTC Health Services is seeking a Credentialing Specialist III on our Provider Credentialing team. You will be responsible for evaluating, analyzing, and coordinating all aspects of the credentialing and privileging processes for providers participating in the LQTC provider network.

Primary Responsibilities:

• Collects, organizes, and maintains accurate and complete documentation related to provider credentials


• Reviews and screens initial and re-credentialing applications for completeness, accuracy, and compliance with LQTC guidelines, policies, and procedures


• Evaluates healthcare providers education, experience, and credentials ensuring provider meets contractual and organizational requirements for participation within LQTC network


• Verifies and maintains the credentials, licenses, certifications, and insurance of healthcare providers, ensuring compliance with organizational, regulatory and accrediting standards


• Ability to perform quality review of healthcare provider credentialing to identify deficiencies and adverse actions


• Maintains and updates credentialing databases, ensuring provider information is current for operational support


• Identify and resolve credentialing issues or discrepancies to ensure accurate and timely credentialing processes


• Review provider contracts for accuracy and completeness


• Provide User Acceptance Testing (UAT) support of IT systems


• Other projects and duties as assigned

Required Qualifications:

• Bachelor’s degree from an accredited college in a related discipline, or equivalent experience/combined education


• 3 to 5 years of relevant experience in healthcare credentialing, privileging, and clinical based practice of medicine; Medical Staff credentialing preferred


• Experience in compliance with accreditation and regulatory standards such as The Joint Commission (TJC) and National Committee for Quality Assurance (NCQA)


• Must be able to successfully pass National Agency Check with Inquiries (NACI) background investigation.

Preferred Qualifications:

• Preferred experience with use of credentialing and privileging software


• Certified Provider Credentialing Specialist (CPCS) a plus

Additional Information: 

• Shift: Monday - Friday 8am - 4:30pm

 About Leidos QTC Health Services

Leidos QTC Health Services collaborates closely with government and non-government customers to address current and future program needs within the health services domain. We specialize in disability-focused medical examinations, independent medical exams and review services, occupational health services, diagnostic testing, and case management solutions. As innovators, we focus on advancing technologies that improve service delivery, with a particular emphasis on enhancing accessibility for examinees in rural communities. With a proven track record of continuous improvement and steady growth, we now handle over 2 million appointments annually. Visit www.qtcm.com for more information.

Compensation and Benefits

Pay and benefits are fundamental to any career decision. That's why we craft compensation packages that reflect the importance of the work we do for our customers. As a result, we offer meaningful and engaging careers to support you and your career goals, all while nurturing a healthy work-life balance. Employment benefits include competitive compensation, Health and Wellness programs, Income Protection, Paid Leave and Retirement. More details are available here.

This role may fall under the Service Contract Act (SCA), a federal law which provides for a U.S. Department of Labor-prescribed minimum prevailing rate of pay and certain benefit levels. Where appropriate, Company-provided benefit plans such as comprehensive leave, holiday, medical, dental, life, accident, disability coverages, retirement plan contributions, and other health and welfare benefits and payments are utilized to meet these obligations. 

Commitment to Non-Discrimination

All qualified applicants will receive consideration for employment without regard to sex, race, ethnicity, age, national origin, citizenship, religion, physical or mental disability, medical condition, genetic information, pregnancy, family structure, marital status, ancestry, domestic partner status, sexual orientation, gender identity or expression, veteran or military status, or any other basis prohibited by law. Leidos QTC Health Services will also consider for employment qualified applicants with criminal histories consistent with relevant laws.

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities

This employer is required to notify all applicants of their rights pursuant to federal employment laws.
For further information, please review the Know Your Rights notice from the Department of Labor.

Compliance

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