Credentialing Specialist - 100% Remote (Must Live in Greater Houston)

Credentialing Specialist

At Houston Methodist, the Credentialing Specialist is responsible for processing applications for appointment and reappointment to the Medical Staff of Houston Methodist hospitals per applicable accreditation, bylaws, and rules and regulations standards and deadlines. Additionally, current and accurate practitioner demographic, licensure, and privileging information will be maintained by this position, utilizing credentialing and other designated software and in hard copy, as required.

Houston Methodist Experience Expectations:

• Provide personalized care and service by consistently demonstrating our I CARE values: INTEGRITY: We are honest and ethical in all we say and do. COMPASSION: We embrace the whole person including emotional, ethical, physical, and spiritual needs. ACCOUNTABILITY: We hold ourselves accountable for all our actions. RESPECT: We treat every individual as a person of worth, dignity, and value. EXCELLENCE: We strive to be the best at what we do and a model for others to emulate.
• Practices the Caring and Serving Model
• Delivers personalized service using HM Service Standards
• Provides for exceptional patient/customer experiences by following our Standards of Practice of always using Positive Language (AIDET, Managing Up, Key Words)
• Intentionally collaborates with other healthcare professionals involved in patients/customers or employees' experiential journeys to ensure strong communication, ease of access to information, and a seamless experience
• Involves patients (customers) in shift/handoff reports by enabling their participation in their plan of care as applicable to the given job
• Actively supports the organization's vision, fulfills the mission, and abides by the I CARE values

Responsibilities:

• Prepares correspondence to practitioners, delegated entities, and others.
• Handles resolution of complex problems and issues and notifies management of issue and resolution.
• Promotes a positive work environment and contributes to a dynamic, team-focused work unit that actively helps one another to achieve optimal department results.
• Receives, data enters, and organizes applications for appointment and reappointment.
• Performs primary source and other verifications necessary for completion of applications for appointment and reappointment.
• Gathers and compiles all other necessary documentation, including case logs or quality data, for application completion.
• Generates reports and checklists for the organization, tracking, auditing, and communication of work in process or completed.
• Ensures all credentialing deadlines are met.
• Investigates, clarifies, and communicates discrepancies, sanctions, complaints, adverse data, etc., as per department policies.
• Ensures data entry, verifications, and final applications are accurate and complete in the credentialing database.
• Updates database on an ongoing basis as necessary.
• Assists with financial management tasks such as dues, fees, and/or payments.
• Participates in department projects and activities.
• Seeks continuing education opportunities to expand learning beyond baseline competencies with a focus on continual development.

This job description is not intended to be all-inclusive; the employee will also perform other reasonably related business/job duties as assigned. Houston Methodist reserves the right to revise job duties and responsibilities as the need arises.

Qualifications:

• High School diploma or equivalent education (examples include: GED, verification of homeschool equivalency, partial or full completion of post-secondary education, etc.)
• Three years of experience in the Medical Staff Credentialing/Privileging function in a hospital setting, with regular interaction and communication with medical staff and hospital leadership
• Three years of experience in word-processing and spreadsheet software such as Microsoft Word and Excel
• Experience with credentialing software preferred

License/Certification:

• LICENSES AND CERTIFICATIONS - REQUIRED: N/A
• LICENSES AND CERTIFICATIONS - PREFERRED: CPMSM - Certified Professional Medical Services Management (NAMSS) OR CPCS - Certified Provider Credentialing Specialist (NAMSS)

Knowledge, Skills, and Abilities:

• Demonstrates the skills and competencies necessary to safely perform the assigned job, determined through on-going skills, competency assessments, and performance evaluations.
• Sufficient proficiency in speaking, reading, and writing the English language necessary to perform the essential functions of this job, especially with regard to activities impacting patient or employee safety or security.
• Ability to effectively communicate with patients, physicians, family members, and co-workers in a manner consistent with a customer service focus and application of positive language principles.
• Self-motivated, detail-oriented, energetic, and able to prioritize multiple projects.
• Knowledge of accreditation standards that relate to Medical Staff Services.
• Computer literacy, including ability to utilize various software programs to complete all job tasks described in job summary. Must be proficient in word-processing and spreadsheet software such as Microsoft Word and Excel. Knowledge of credentialing software preferred.
• General knowledge of medical terminology.
• Ability to complete work within designated time frames.
• Ability to offer suggestions and implement change to enhance efficiency and organization of office operations.
• Ability to maintain confidentiality and privacy of practitioner files.

Supplemental Requirements:

• WORK ATTIRE: Business professional Yes
• ON-CALL* No
• TRAVEL** Yes

Company Profile:

Houston Methodist (HM) is one of the nation's leading health systems and academic medical centers. HM consists of eight hospitals: Houston Methodist Hospital, its flagship academic hospital in the heart of the Texas Medical Center, and seven community hospitals throughout the greater Houston metropolitan area. HM also includes an academic institute, a comprehensive residency program, a global business division, numerous physician practices, and several free-standing emergency rooms and outpatient facilities. Overall, HM employs over 25,000 employees. Houston Methodist is supported by a wide variety of business functions that operate at the system level to help enable clinical departments to provide the best patient care and service in a spiritual environment.

In 2019 Houston Methodist and its physicians treat more than 6,333 international patients from more than 76 countries. Houston Methodist Global Health Care Services' consulting and education divisions also provide advisory services and training and development to health care organizations around the world.