Credentialing Specialist

Join us as a Credentialing Specialist at Memorial Hermann Health System.

Under general supervision, the Credentialing Specialist will be responsible for conducting activities related to initial credentialing, re-credentialing, delegation, facility credentialing, and ongoing provider file maintenance, typically reporting to the Credentialing Manager.

• Process provider applications and re-applications including initial mailing, review, and loading; coordinate the distribution of emails, mail‑outs, or other documents to customers.
• Assist in the implementation of procedures and activities related to the credentialing, re-credentialing, and privileging of network providers.
• Maintain the provider profiling system and communicate with providers by phone and mail regarding credentialing status.
• Track, maintain, and update licensure: DEA and state narcotics certification or other expiring credentials; coordinate with physician office to obtain expiring documents.
• Answer internal and external customer phone calls; provide physicians with credentialing application status updates in a timely and professional manner; elevate concerns appropriately.
• Monitor physician sanction sources and board actions, escalating alerts as needed.
• Perform basic data entry on credentialing applications.
• Ensure safe care to patients, staff, and visitors; adhere to all Memorial Hermann policies, procedures, and standards within budgetary specifications including time management, supply management, productivity, and quality of service.
• Promote individual professional growth and development by meeting requirements for mandatory/continuing education and skill competency; support department-based goals; serve as preceptor, mentor and resource to less experienced staff.
• Model Memorial Hermann’s service standards by providing safe, caring, personalized, and efficient experiences to patients and colleagues.
• Other duties as assigned.

• Associate’s degree preferred.
• One (1) year of credentialing experience in a managed care plan, medical staff services, or credentialing verification office.
• Effective analytical skills with the ability to assess compliance, record, analyze, and interpret data into meaningful formats.
• Effective oral and written communication skills.
• Basic computer skills (Microsoft Office, Word, Excel).
• Basic understanding of credentialing Joint Commission, NCQA, and URAC accreditation standards.
• Demonstrated ability to work independently and collaboratively with a team and multiple departments, taking full responsibility for tasks.