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Credentialing Coordinator

Houston, TX 77030

Posted: 05/10/2024 Category: Medical Secretary Job Number: 39068 Approx. Rate per Hour (negotiable): 22.00 Branch: Houston Office Industry: Medical

Job Description

Hire Up Staffing is looking for a skilled Credentialing Coordinator for a position in the Medical Center. 

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:

  1. 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.

  2. 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.

  3. 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.

  4. 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.

  5. 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.

  • 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.
If this is something that you are qualified for and interested in please apply today! 


Additional Information

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Career Expert

Nicole DeShong
Branch Manager

Meet Nicole, our Branch Manager on the South TX team! Nicole has previously worked in various fields, from a Fish Grader and Forklift Operator at a Fish Cannery in Alaska to Medical Billing and Account Management for Anesthesiologists and Pain Management Clinics. She found staffing was her passion when she started credentialing and worked her way up in the industry. A work-related accomplishment she is proud of is being able to grow into roles of responsibility. Starting from an entry-level and learning the ropes of various jobs helped her become successful in management roles at almost every company she has worked at. One goal that Nicole has now is growth! She doesn't want to be in a position because it is comfortable. She wants to be challenged and succeed and be able to help and grow others. Nicole is excited to work at Hire Up Staffing because she is part of a team with the structure and support necessary to grow all employees, both internally and externally. When she is outside the office, you can find Nicole spending time with her kids, camping, fishing, concerts, and being outdoors.

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