Quality Audit Credentialing Specialist II

HCA Healthcare, Inc.; Houston (TX); Remote; USD 65,000 - 90,000; Full time

Benefits offered by this job

Comprehensive benefits

401(k) plan with match

Education support

Job summary

Parallon, a part of HCA Healthcare, seeks a Credentialing Processing Center Specialist II to safeguard patient well-being by ensuring verified credentials across hospitals and facilities. The role involves navigating complex regulatory guidelines and coordinating with a wide network of providers and stakeholders.

The ideal candidate has 5+ years in healthcare credentialing, familiarity with Joint Commission/NCQA standards, and NAMSS certification preferred.

Qualifications

• Associate degree or equivalent required; bachelor’s preferred.
• 5+ years’ healthcare credentialing experience with Parallon or HCA.
• Experience with Joint Commission or NCQA accreditation preferred.
• Deep knowledge of healthcare credentialing laws, standards, and regulatory agencies.
• NAMSS Certification preferred.
• Remote employees must live within 60 miles of an HCA hospital.
• Remote employees must have wired internet with 25 Mbps download and 15 Mbps upload.

Responsibilities

• Master regulatory guidelines and internal policies; manage 350+ internal and external customers.
• Forges collaborative partnerships with 350+ facilities, customers and stakeholders.
• Review Data Integrity, Specialist, and Compliance Reviews to identify practitioner risk.
• Ensure credentialing of medical and allied providers is timely and accurate.

Skills

Regulatory guidelines

Communication

Stakeholder management

Risk identification

Audit/compliance

Education

Associate’s degree or equivalent

Bachelor’s degree preferred

Job description

Do you want to join an organization that invests in you as a Quality Audit Specialist II? At Parallon, you come first. HCA Healthcare has committed up to $300 million in programs to support our incredible team members over the course of three years.

Candidate must live within 60 miles of a HCA facility in FL, GA, ID, KS, KY, MO, NC, NH, NV, SC, TN, TX, UT and VA.

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.

In this role you will:

• 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

Parallon, offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and programs include:

• 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 (https://careers.hcahealthcare.com/pages/employee-benefits-and-rewards)

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.

"Good people beget good people."- Dr. Thomas Frist, Sr.

HCA Healthcare Co-Founder

We are a family 270,000 dedicated professionals! Our Talent Acquisition team is reviewing applications for our Quality Audit Specialist II opening. Qualified candidates will be contacted for interviews.

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.