Credentialing Specialist

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.

• Manage the process of sending initial and/or reappointment applications and monitoring their return with required documents
• Responsible for processing appointment/reappointment applications in an accurate, thorough, and timely manner; clearly and succinctly communicate reappointment status to applicant in writing
• File appointment/reappointment applications and other communication as needed
• Prepare files other documents, as requested, for review and evaluation of the clinical Service Chief and Credentials Committee in an accurate, consistent, professional, and organized manner
• Perform 3rd party verifications of submitted material as required by department policy, medical staff policy, and the Bylaws of the Medical Staff
• Document receipt of application materials and verifications in the credentialing system (ECHO) (e.g. Texas Medical License, Malpractice Insurance, DEA, Board Certification, DPS, etc.). File copy in physician's file

Required

• High School Graduate General Studies, upon hire or
• High School GED General Studies

Baylor St. Luke’s Medical Center is an internationally recognized leader in research and clinical excellence that has given rise to breakthroughs in cardiovascular care, neuroscience, oncology, transplantation, and more. Our team’s efforts have led to the creation of many research programs and initiatives to develop advanced treatments found nowhere else in the world. In our commitment to advancing standards in an ever-evolving healthcare environment, 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. Our strong alliance with Texas Heart® Institute and Baylor College of Medicine allows us to bring our patients a powerful network of care unlike any other. Our collaboration is focused on increasing access to care through a growing network of leading specialists and revolutionizing healthcare to save lives and improve the health of the communities we serve.