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Credentialing Coordinator
7007 Bertner Ave. Houston, TX 77030 US
Job Description
Hybrid Schedule
M-F 8a-5p
As a Credentialing Coordinator, you will play a crucial role in ensuring that our organization's healthcare professionals meet all requirements and standards for credentialing and privileging. You will manage the credentialing process from start to finish, ensuring accuracy, compliance, and efficiency.
Key Responsibilities:
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Credentialing Process Management:
- Coordinate and facilitate the credentialing and re-credentialing processes for healthcare providers, including physicians, nurses, allied health professionals, and other staff.
- Collect, review, and verify all necessary documentation and information required for credentialing, privileging, and enrollment in various healthcare networks and insurance plans.
- Maintain up-to-date knowledge of credentialing requirements, regulations, and accreditation standards, ensuring compliance with all relevant laws and guidelines.
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Provider Enrollment:
- Initiate and manage the provider enrollment process with various payers, including Medicare, Medicaid, and commercial insurance plans.
- Ensure timely completion and submission of enrollment applications, contracts, and other required documents to facilitate provider participation in reimbursement programs.
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Database Management:
- Maintain accurate and comprehensive credentialing databases and electronic files for all healthcare providers, ensuring data integrity and confidentiality.
- Track credentialing and privileging expirations, proactively initiating re-credentialing processes as needed to maintain compliance and continuity of care.
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Communication and Collaboration:
- Serve as the primary point of contact for internal stakeholders, external agencies, and healthcare providers regarding credentialing matters.
- Collaborate closely with departmental leaders, human resources, legal, and compliance teams to ensure alignment of credentialing processes with organizational goals and policies.
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Quality Assurance and Performance Improvement:
- Conduct regular audits and quality assurance reviews of credentialing files and processes to identify areas for improvement and ensure adherence to best practices.
- Implement corrective actions and process enhancements to optimize efficiency, accuracy, and compliance with accreditation standards and regulatory requirements.
Qualifications:
- Bachelor's degree in healthcare administration, business administration, or related field (preferred).
- Previous experience in credentialing, provider enrollment, or healthcare administration.
- Knowledge of credentialing standards, regulations, and accreditation requirements.
- Strong attention to detail and organizational skills, with the ability to manage multiple priorities and deadlines effectively.
- Excellent communication and interpersonal skills, with the ability to collaborate effectively with diverse stakeholders.
- Commitment to maintaining confidentiality and upholding ethical standards in all aspects of work.
- CPCS or CPMSM Certifications preferred.
INDHP HUH
Additional Information
Career Expert
Nicole DeShong
Branch Manager
Nicole has always had a passion for helping others, and she initially thought her career path would lead her into social services. However, she soon discovered that her true calling was in guiding people toward career opportunities and supporting them through the job search process. Today, Nicole excels in helping individuals navigate the complexities of their career journeys.
One of her proudest professional achievements is the growth she’s experienced throughout her career. Starting in entry-level roles and learning the ins and outs of various positions has allowed her to take on increasing responsibilities and succeed in management roles across multiple companies. Nicole is particularly passionate about building and mentoring teams, and she thrives on teaching others the industry from the ground up.
At Hire Up Staffing, Nicole is excited to be part of a team that offers the structure and support necessary to foster growth—both for employees and for clients.
Outside the office, Nicole enjoys spending time with her family, attending Astros games, and enjoying the outdoors.