Manager, Credentialing & Provider Enrollment

TCH Medical Center; Houston (TX); On-site; USD 90,000 - 120,000; Full time

Job summary

Texas Children’s Medical Staff seeks a Centralized Credentialing Manager to maintain the credentialing program for TCPSO, ensuring compliance with federal, state, and accrediting bodies while leading credentialing staff.

The role emphasizes policy upkeep, audits, staff training, and collaboration with other departments to meet NCQA and TJC requirements across the integrated delivery system.

Qualifications

• 8 years experience in a healthcare credentialing or related area.
• Supervisory or managerial experience preferred.
• Knowledge of credentialing processes and regulatory standards.

Responsibilities

• Manages a Credentialing Program meeting regulatory and accrediting body requirements.
• Responsible for credentialing responses to regulatory audits.
• Train Centralized Credentialing staff to maintain up-to-date knowledge for quality, regulatory, or malpractice issues.
• Handles credentialing and re-credentialing for TCPSO members and Texas Children’s Medical Staff.
• Oversees credentialing for practitioners under delegated payor agreements.
• Maintains a current database of credentialed practitioners.
• Ensures credentialing follows Joint Commission requirements and NCQA/TJ C guidelines.
• Collaborates with other departments to meet NCQA and TJC requirements.

Skills

Healthcare leadership

Supervisory experience

Regulatory compliance

Credentialing knowledge

Education

Bachelor's degree

Job description

We are searching for a Centralized Credentialing Manager – someone who works well in a fast-paced setting. In this position, you’ll be responsible for maintaining the Practitioner and Facility Credentialing Program for Texas Children's Medical Staff and Texas Children's Physician Group (TCPSO). This role will be primarily responsible for maintaining policies and processes in compliance with all applicable federal, state, and nationally recognized regulatory and/or accrediting bodies, and overseeing credentialing staff in the preparation of all credential files and reports to ensure compliance.

Job Duties & Responsibilities

• Manages a Credentialing Program that meets regulatory and accrediting body requirements
• Responsible for Credentialing responses to regulatory audits
• Responsible for training of Texas Children’s Centralized Credentialing staff to ensure a comprehensive, up to date knowledge base for identifying potential quality, regulatory, or malpractice issues early in credentialing process
• Responsible for credentialing and re-credentialing functions for practitioners seeking to join the Texas Children’s Medical Staff and/or become a member of the TCPSO through direct credentialing
• Oversees credentialing and re-credentialing functions for practitioners privileged through the Texas Credentials Committee or approved as a member of the TCPSO accessing payor’s delegated agreements
• Maintains a current and accurate database of all credentialed practitioners
• Ensures that the credentialing and reappointment process for the Medical Staff follow Joint Commission (TJC) requirements as outlined in the TCH Bylaws and Rules and Regulations and understand the linkage between your department’s requirements and those of the integrated delivery system
• Ensures that NCQA requirements specific to the TCPSO Credentialing program are fulfilled and understands the linkage between the TCH Centralized Credentialing department’s requirements and those of the integrated delivery system
• Collaborates with colleagues in other departments to ensure all NCQA and TJC requirements are met

Skills & Requirements

• High School Diploma or GED is required; Associate’s or Bachelor’s degree is preferred
• A Bachelor’s degree may substitute for 4 years and an Associate’s degree may substitute for 2 years
• Certified Professional Medical Services Management or Certified Provider Credentialing Specialist license is preferred
• 8 years experience in a healthcare delivery environment, hospital, physician practice, physician billing, credentialing, managed care, provider engagement, and/or privileging environment required
• Previous supervisory or managerial experience highly desired

Highly Desired Skills/Knowledge

Revenue Cycle, Revenue Cycle Analyst, Billing, Coding