Credentialing Specialist

Position: Credentialing Manager

Location: Fort Worth, TX 76107

Duration: 6 months Contract to Hire

Job Details:

Responsible for managing a team of credentialing specialists and daily functions. Accountable for systems and processes that ensure compliance with organizational credentialing policies and procedures. Ensures compliance with the credentialing requirements of Client’s health plan partners, and related regulatory and accrediting agency requirements.

Essential Functions

Manage the credentialing and re-credentialing process for Providers, including primary source verification, notification of requirements, coordination with other departments, and proper documentation.

Oversee the privileging process by developing and maintaining application packets and procedures, ensuring compliance with agency guidelines.

Coordinate and chair credentialing committee meetings, preparing agendas, analyzing applications, and facilitating discussions on issues identified through various feedback channels.

Provide consultation, training, and resource information to programs/contractors as needed, and participate in Quality Management and other committee meetings.

Maintain proficiency in computer software applications specific to credentialing functions and provide training to the team.

Assist with external audit preparation, coordinate improvement plans, and participate in surveys and evaluations for outside agencies as assigned.

Qualify applications, resumes, and bids by evaluating minimum qualifications, obtaining transcripts, and reviewing personnel files for transfers/promotions.

Demonstrate professionalism and discretion while organizing and participating in interdisciplinary meetings to improve communication and collaboration.

Execute strategic plans effectively and maintain compliance with Client Tarrant and agency guidelines throughout all processes.

Performance standards are performed as applicable with Client’s We CARE values “We Connect People in Our Community. We Provide Access to Services. We Link People to Resources. We Empower People.”

Performs other job duties or responsibilities as requested or assigned.

Knowledge of Laws, Regulations, Policies/Procedures, Skills, and Abilities

Knowledge of Federal and State laws and Requirement(s) pertaining to Credentialing, HR, Personnel Management, and TA.

Demonstrates ability to positively lead, manage and motivate team members.

Ability to work independently and proactively in a fast-paced, dynamic environment.

Highly initiative-taking and proactive.

Flexible and adaptable regarding learning and understanding new technologies and processes.

Able to communicate effectively within department and with members of interdisciplinary teams.

Ability to effectively prioritize and execute tasks in a high-pressure environment.

Highly analytical and detail-oriented with ability to demonstrate command of details.

Strong interpersonal, written, and oral communication skills.

Experience working both independently and collaborative environment.

Analytical and problem-solving abilities.

Proficient and skilled in word processing and information systems, particularly in the use of Windows software applications, Microsoft Word, Microsoft Excel, and CMHC.

Knowledge of Requirement(s) applicable to community centers including Rules of the TX OARS, TX DADS, CARF, Requirement(s) for Community Services, ICF/IDD, HCS, HHS JCAHO, NCQA, TRC, ECI, DPRS and DSHS, and ability to interpret the Requirement(s).

Knowledge of survey, sampling, data collection, and interviewing techniques.

Ability to understand and implement the Utilization Management/Quality Management process as it applies to Client Tarrant.

Knowledge and application of confidentiality laws.

Proactive, responsive, and resourceful with excellent follow-up and organizational skills

Minimum Qualifications

Minimum Education: Bachelor’s Degree

Defined Education: Business, Human Resources, Healthcare Administration, Health and Human Services, Behavioral Science or a related field.

Substitutions: Master’s Degree with two (2) years’ experience and two (2) years supervisory experience

Years’ Experience: Four (4) years

Defined Experience: Experience doing credentialing in a human services agency, Community Center, healthcare facility, academic or research setting.

License/Certifications: Valid Texas Driver’s License; CPMSM – NAMMS (Certified Professional Services Management from the National Association of Medical Staff Services), required or must obtain within one year of hire.

Job Type: Contract

Pay: $38.00 per hour

Schedule:

• 8 hour shift
• Day shift
• Monday to Friday

Application Question(s):

• CPMSM – NAMMS (Certified Professional Services Management from the National Association of Medical Staff Services), required or must obtain within one year of hire.
• Are you comfortable with 6 Months Contract to hire?

Education:

• Bachelor's (Required)

Experience:

• Credentialing: 3 years (Required)

Work Location: In person

Salary : $38