Credentialing Specialist II

HCA Healthcare; Houston (TX); On-site; USD 60,000 - 80,000; Full time

Benefits offered by this job

Medical, dental, vision benefits

401(k) with company match

Tuition assistance

Dependent scholarships

Life insurance

Job summary

The Credentialing Processing Center Specialist II at HCA Healthcare safeguards patient well-being by ensuring hospitals and facilities have verified credentials and compliant documentation. You will collaborate with internal teams and external providers, manage credentialing documents, and follow up on missing information to support timely, accurate credentialing across the enterprise.

You’ll apply regulatory guidelines and coordinate with numerous stakeholders to maintain high credentialing

Qualifications

• Associate’s degree or equivalent work experience; bachelor’s degree preferred.
• 5+ years in healthcare credentialing with Parallon or HCA required.
• Experience with Credentialing Accreditation by Joint Commission or NCQA preferred.
• Knowledge of healthcare regulatory and credentialing standards.
• NAMSS Certification preferred.
• Remote employees live within 60 miles of an HCA hospital.
• Must have wired internet with 25 Mbps download and 15 Mbps upload.

Responsibilities

• Safeguards patient well-being by ensuring hospitals possess verified practitioner credentials.
• Collaborates with over 350 facilities, customers, and stakeholders.
• Identifies potential practitioner risks and supports issue resolution per policy.
• Ensures timely, accurate credentialing and adherence to regulatory standards.
• Documents resolutions and escalations in practitioner files for audits.

Skills

Communication

Regulatory guidelines

Relationship building

Compliance

Education

Associate degree or equivalent

Bachelor’s degree preferred

Job description

Experience the HCA Healthcare difference where colleagues are trusted, valued members of our healthcare team. Grow your career with an organization committed to delivering respectful, compassionate care, and where the unique and intrinsic worth of each individual is recognized. Credentialing Specialist II.

Schedule: Monday-Friday 9:30AM-6:00PM CST.

Seeking candidates that live in the Mountain Standard Time and Pacific Standard Time time zones.

Job Summary And Qualifications

The Credentialing Processing Center Specialist II is responsible for safeguarding the patient well-being and elevating clinical excellence across our healthcare enterprise by meticulously ensuring hospitals and other healthcare facilities possess comprehensive, verified practitioner legally required credentials. This role is pivotal in empowering informed decisions regarding practitioner access, directly impacting the thousands of lives under our care daily.

• Mastery communication and regulatory guidelines, policies, procedures, and internal systems, coupled with keen insight into practitioner 350+ internal customers, plus external customers.
• Forges collaborative partnerships with over 350+ healthcare facilities, customers, and stakeholders.
• Mastered competency and acquired extensive experience through review of Data Integrity Reviews, Specialist Reviews, and Compliance Reviews, that supports precise accurate identification of potential practitioner issues and flagging of practitioner risk.
• Adheres to stringent regulatory guidelines, Joint Commission Standards, Facility Bylaws and CPC standards.
• Ensures the flawless, timely, and accurate credentialing of medical and allied healthcare providers, upholding the highest standards of quality
• Mastered through experience and exposure to complex credentialing documents and verifications the competency to discern, identify and elevate practitioner risk concerns by utilizing the policies, procedures, verification elements, or regulatory guidelines as validation. In addition, competency, and experience that supports the identification of potential risk outside of policy requirements.
• Orchestrates the comprehensive collection of all pertinent information, strategically managing follow-up for missing or incomplete documentation through effective communication and relationship building with practitioners and other external organizations.
• Identifies and analyzes potential compliance flags and master the skill set through experience to collaborate with practitioners on sensitive issues and other external organization, such as drug addiction centers or anger management centers, to accurate document or resolve sensitive and confidential practitioner issues.
• Mastered the ability to meticulously document resolution and/or unresolved complex issues and escalations as needed in practitioner files that may support future lawsuits.
• Possesses expertise knowledge to contribute valuable insight into the strategic development and implementation of policy frameworks, and participates in comprehensive audits, ensuring regulatory adherence.
• Provides strategic counsel to Managers and Directors regarding ambiguous information, and escalates critical issues identified during credentialing processes with expediency and precision.
• Maintains meticulous credentialing records, guaranteeing the accurate scanning and secure storage of all correspondence within mandated timeframes.
• Upholds unwavering compliance with all governing policies, procedures, and Federal and State regulatory and accrediting agency requirements.

Qualifications:

• Associate’s degree or equivalent work experience. Bachelor’s degree preferred
• 5+ years’ experience in healthcare credentialling with Parallon or HCA required
• Experience with Credentialing Accreditation by Joint Commission or National Committee for Quality Assurance, preferred.
• Detailed working knowledge of the health care and credentialing industry, including medical-legal issues and laws, regulatory agencies, and other national standards preferred
• NAMSS Certification preferred.
• Remote employees are required to live within 60 miles of an HCA hospital
• Remote employees are required to have wired (Cable or fiber) internet access with 25 MBS Download and 15 MBS Upload.

Benefits

• Comprehensive benefits for medical, prescription drug, dental, vision, behavioral health and telemedicine services
• Wellbeing support, including free counseling and referral services
• Time away from work programs for paid time off, paid family leave, long- and short-term disability coverage and leaves of absence
• Savings and retirement resources, including a 401(k) Plan with a 100% match on 3% to 9% of pay (based on years of service), Employee Stock Purchase Plan, flexible spending accounts, preferred banking partnerships, retirement readiness tools, rollover support and financial wellbeing counseling
• Education support through tuition assistance, student loan assistance, certification support, dependent scholarships and a partnership with Galen College of Nursing
• Additional benefits for fertility and family building, adoption assistance, life insurance, supplemental health protection plans, auto and home insurance, legal counseling, identity theft protection and consumer discounts

Learn More About Employee Benefits

Note: Eligibility for benefits may vary by location.

"Parallon provides full-service revenue cycle management, or total patient account resolution, for HCA Healthcare. Our services include scheduling, registration, insurance verification, hospital billing, revenue integrity, collections, payment compliance, credentialing, health information management, customer service, payroll and physician billing. We also provide full-service revenue cycle management as well as targeted solutions, such as Medicaid Eligibility, for external clients across the country. Parallon has over 17,000 colleagues, and serves close to 1,000 hospitals and 3,000 physician practices, all making an impact on patients, providers and their communities.
HCA Healthcare has been recognized as one of the World’s Most Ethical Companies® by the Ethisphere Institute more than ten times. In recent years, HCA Healthcare spent an estimated $3.7 billion in cost for the delivery of charitable care, uninsured discounts, and other uncompensated expenses.
\"There is so much good to do in the world and so many different ways to do it.\"- Dr. Thomas Frist, Sr.
HCA Healthcare Co-Founder

We are an equal opportunity employer. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.