Job Description

At Houston Methodist, the Credentialing Specialist position is responsible for processing applications for appointment and reappointment to the Medical Staff of Houston Methodist hospitals per applicable accreditation, bylaws and rules and regulations standards and deadlines. Additionally, current and accurate practitioner demographic, licensure and privileging information will be maintained by this position, utilizing credentialing and other designated software and in hard copy, as required.

Requirements:

PEOPLE ESSENTIAL FUNCTIONS

• Prepares correspondence to practitioners, delegated entities and others.

• Handles resolution of complex problems and issues and notifies management of issue and resolution.

• Promotes a positive work environment and contributes to a dynamic, team-focused work unit that actively helps one other to achieve optimal department results.

SERVICE ESSENTIAL FUNCTIONS

• Receives, data enters and organizes applications for appointment and reappointment.

• Performs primary source and other verifications necessary for completion of applications for appointment and reappointment.

• Gathers and compiles all other necessary documentation, including case logs or quality data, for application completion.

• Generates reports and checklists for the organization, tracking, auditing and communication of work in process or completed.

• Ensures all credentialing deadlines are met.

QUALITY/SAFETY ESSENTIAL FUNCTIONS

• Investigates, clarifies and communicates discrepancies, sanctions, complaints, adverse data, etc., as per department policies.

• Ensures data entry, verifications and final applications are accurate and complete in the credentialing database.

• Updates database on an ongoing basis as necessary.

FINANCE ESSENTIAL FUNCTIONS

• Assists with financial management tasks such as dues, fees, and/or payments.

GROWTH/INNOVATION ESSENTIAL FUNCTIONS

• Participates in department projects and activities.

• Seeks continuing education opportunities to expand learning beyond baseline competencies with a focus on continual development.

This job description is not intended to be all-inclusive; the employee will also perform other reasonably related business/job duties as assigned. Houston Methodist reserves the right to revise job duties and responsibilities as the need arises.

Qualifications:

EDUCATION

• High School diploma or equivalent education (examples include: GED, verification of homeschool equivalency, partial or full completion of post-secondary education, etc.)

WORK EXPERIENCE

• Three years of experience in the Medical Staff Credentialing/Privileging function in a hospital setting, with regular interaction and communication with medical staff and hospital leadership

• Three years of experience in word-processing and spreadsheet software such as Microsoft Word and Excel

• Experience with credentialing software preferred

LICENSES AND CERTIFICATIONS - REQUIRED

• N/A

LICENSES AND CERTIFICATIONS - PREFERRED

• CPMSM - Certified Professional Medical Services Management (NAMSS) OR
• CPCS - Certified Provider Credentialing Specialist (NAMSS)

KNOWLEDGE, SKILLS, AND ABILITIES

• Demonstrates the skills and competencies necessary to safely perform the assigned job, determined through on-going skills, competency assessments, and performance evaluations

• Sufficient proficiency in speaking, reading, and writing the English language necessary to perform the essential functions of this job, especially with regard to activities impacting patient or employee safety or security

• Ability to effectively communicate with patients, physicians, family members and co-workers in a manner consistent with a customer service focus and application of positive language principles

• Self-motivated, detail-oriented, energetic, and able to prioritize multiple projects

• Knowledge of accreditation standards that relate to Medical Staff Services

• Computer literacy, including ability to utilize various software programs to complete all job tasks described in . Must be proficient in word-processing and spreadsheet software such as Microsoft Word and Excel. Knowledge of credentialing software preferred

• General knowledge of medical terminology

• Ability to complete work within designated time frames

• Ability to offer suggestions and implement change to enhance efficiency and organization of office operations

• Ability to maintain confidentiality and privacy of practitioner files

SUPPLEMENTAL REQUIREMENTS

WORK ATTIRE

• Uniform No
• Scrubs No
• Business professional Yes
• Other (department approved) No

ON-CALL*
*Note that employees may be required to be on-call during emergencies (ie. DIsaster, Severe Weather Events, etc) regardless of selection below.

• On Call* No

TRAVEL**
**Travel specifications may vary by department**

• May require travel within the Houston Metropolitan area Yes
• May require travel outside Houston Metropolitan area No

Job Tags

Similar Jobs