Credentialing Specialist

CommonSpirit Health; Houston (TX); On-site; USD 60,000 - 75,000; Full time

Job summary

St. Joseph Health in Brazos Valley region seeks a Credentialing Professional to coordinate credentialing, re-credentialing, and payer enrollment for providers in line with policies and regulatory requirements.

You will manage daily credentialing operations, resolve non-responsive providers, and collaborate with clinic managers and the medical staff office to ensure timely completion of delegated credentialing tasks.

Qualifications

• Knowledge of credentialing regulations and regulatory requirements.
• Strong organizational and communication skills.
• Ability to manage multiple credentialing workflows and complex administrative tasks.

Responsibilities

• Manage the process of sending initial and/or reappointment applications and monitoring their return with required documents.
• Process appointment/reappointment applications accurately and communicate status in writing.
• File appointment/reappointment applications and other communications as needed.
• Prepare files for review by the clinical Service Chief and Credentials Committee in a professional and organized manner.
• Perform third-party verifications of submitted materials as required by policy and bylaws.
• Document receipt of application materials and verifications in the credentialing system (ECHO) and file copies in physician files.

Skills

Credentialing regulations knowledge

Organizational skills

Communication skills

Attention to detail

Documentation management

Education

High School Diploma or GED

Tools

ECHO credentialing system

Job description

Job Summary and Responsibilities

As a Credentialing Professional, you will be responsible for coordinating the credentialing, re-credentialing, and payer enrollment process for providers in accordance with delegated credentialing agreements, policies and procedures, industry best practices, and regulatory requirements.

Every day you will manage daily credentialing operations, including resolution of non-responsive providers. You will also work collaboratively with various clinic managers and the hospital medical staff office to ensure the successful and timely completion of the delegated credentialing and re-credentialing process.

To be successful in this role, you will demonstrate a comprehensive understanding of credentialing regulations and processes, possess strong organizational and communication skills, and effectively manage complex administrative tasks to ensure provider compliance and efficient operational flow.

• Manage the process of sending initial and/or reappointment applications and monitoring their return with required documents
• Responsible for processing appointment/reappointment applications in an accurate, thorough, and timely manner; clearly and succinctly communicate reappointment status to applicant in writing
• File appointment/reappointment applications and other communication as needed
• Prepare files other documents, as requested, for review and evaluation of the clinical Service Chief and Credentials Committee in an accurate, consistent, professional, and organized manner
• Perform 3rd party verifications of submitted material as required by department policy, medical staff policy, and the Bylaws of the Medical Staff
• Document receipt of application materials and verifications in the credentialing system (ECHO) (e.g. Texas Medical License, Malpractice Insurance, DEA, Board Certification, DPS, etc.). File copy in physician's file

Job Requirements

Required

• High School Graduate General Studies, upon hire or
• High School GED General STudies, upon hire
• None, upon hire

Where You'll Work

St. Joseph Health has been caring for the communities in and surrounding the Brazos Valley since 1936 (Bryan/College Station, Navasota, Caldwell, Madisonville (TX)). St. Joseph has a Level III Trauma Center, the first Joint Commission certified Primary Stroke Center and the first accredited Chest Pain Center in the Brazos Valley.

St. Joseph Health is a leader in critical care and the largest provider of cardiovascular care in the region. As an integrated healthcare system St. Joseph Health includes a comprehensive network of over 100 employed providers including primary care physicians specialists and advanced practice clinicians. The network includes more than 30 ambulatory clinics featuring Primary Care, Express Clinics and Imaging and Diagnostic Services.