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.
- Initiates and coordinates the collection of primary source information for credentialing purposes at the division level. Verifies, compiles, manages and maintains confidential research required for credentialing of initial appointment and reappointment applicants. Processes applications according to established legal, State and Federal agencies, State licensing board, regulatory and facility standards. Coordinates, tracks, and monitors flow of information to ensure the timely processing and notification of applicants in accordance with the guidelines established.
- Conducts thorough analysis of all primary source documentation received for assessment of qualifications/competencies. Assures appropriate education and training including procedural documentation has been provided to support clinical privileges requested. Identifies any potential quality of care issues, behavioral problems, and/or other issues, escalating as necessary. Summarizes and prepares credentialing information, including information about flagged concerns, for review and decisions. Applies the credentials evaluation process uniformly to all initial appointment and reappointment applications to ensure compliance with St. Luke's Health credentialing policies, procedures and applicable Medical Staff Bylaws. Compiles information regarding CME credits and other requirements in accordance with state licensing requirements and Division policy.
- Facilitates review and assessment of documentation for each application. Serves as the Central Verification Office (CVO) primary point of contact for practitioners during appointment and reappointment process. Must be available to guide practitioners through the process and clearly communicate requirements.
- Maintains an accurate, secure and current database of physician and advanced practitioner/allied health professional information. Proficient with MSOW, Cactus or similar credentialing platform. Follows data entry policy.
- Appropriately escalates concerns regarding credentialing documents and/or timeliness of the verification process. Communicates with facilities appropriately and in a timely manner according to policy. Maintains confidentiality.
- Monitors and maintains all required expirables.
Job Requirements
Required
- High School Graduate General Studies and Minimum of one (1) year of experience in medical staff services, hospital administrative department or credentialing verification organization. , upon hire or
- High School GED General Studies and Minimum of one (1) year of experience in medical staff services, hospital administrative department or credentialing verification organization. , upon hire and
- Comparable healthcare or managed care work experience may be considered and
- None, upon hire
Preferred
- Credentialing database experience, MSOW or Cactus
Where You'll Work
Baylor St. Luke's Medical Center is an 1,045 bed facility located in the Texas medical center. A joint venture with Baylor College of Medicine, Baylor St. Luke's is an internationally recognized leader in research and clinical excellence that has given rise to breakthroughs in cardiovascular care, neuroscience, oncology, transplantation, and more. The hospital is home to the Dan L Duncan Comprehensive Cancer Center, a nationally-accredited and NCI-designated comprehensive cancer center. Our new McNair Campus is designed around the human experience-modeled on evidence-based practices for the safety of patients, visitors, staff, and physicians. The 27.5-acre campus represents the future of healthcare through a transformative alliance focused on leading-edge patient care, research, and education.