Credentialing Specialist I - Medical Staff Services

JOB SUMMARY:

Responsible for all aspects of the credentialing, re-credentialing, and privileging processes for all medical staff members who provide patient care, treatment, and service at UTMB Hospitals and Clinics.

ESSENTIAL JOB FUNCTIONS:

• Facilitates maintaining a comprehensive credentialing program to ensure compliance with the Medical Staff Bylaws, Rules and Regulations and other accrediting and regulatory agencies such as the Joint Commission, NCQA and URAC.
• Participates and coordinates in the credentialing process for the medical staff, allied health professionals and temporary privileges by presenting and reviewing the files with the appropriate medical staff leadership.
• Enters accurate and up to date data of new providers into the credentialing database to include, but not limited to, demographic and personal information, education/training, licensure, DEA, liability information, board certification status, NPI numbers, ECFMG certifications.
• Conducts thorough background investigation, research, and primary source verification of all components of the credentialing application prior to view of the Department Chair.
• Ensures that all expired credentials are reviewed, obtained, and managed on a timely basis according to the credentialing policy and procedures.
• Ensures a timely and accurate preparation of the FPPE evaluation for providers that requested new and additional privileges.
• Partner with Faculty Relations and Provider Enrollment on issues related to recruitment and Enrollment.
• Provides and engages in excellent customer service with members of the Medical Staff, Hospital Administration and other entities related to organization/department.
• Maintains confidentiality of all business/work and medical staff information
• Works under the supervision of the Medical Staff Services Director or Manager.
  
  

MARGINAL OR PERIODIC JOB FUNCTIONS:

• Performs related duties as required.
  
  

REQUIRED EDUCATION / EXPERIENCE:

• Associate degree or equivalent and three years of relevant credentialing experience.
• CPCS Certification preferred.
• Excellent attention to detail.
• Ability to work independently and determine work priorities.
• Ability to communicate effective, both orally and in writing.
• Knowledge of related accreditation and certification requirements.
• Database management skills, including querying, reporting, and document generation.
  
  

Equal Employment Opportunity

UTMB Health strives to provide equal opportunity employment without regard to race, color, religion, age, national origin, sex, gender, sexual orientation, gender identity/expression, genetic information, disability, veteran status, or any other basis protected by institutional policy or by federal, state or local laws unless such distinction is required by law. As a VEVRAA Federal Contractor, UTMB Health takes affirmative action to hire and advance women, minorities, protected veterans and individuals with disabilities.

Primary Location

United States-Texas-Galveston

Work Locations

0519 - John Sealy Annex

Job

Business, Managerial & Finance

Organization

UTMB Health

Regular

Shift

Standard

Employee Status

Non-Manager

Job Level

Day Shift

Job Posting

Jan 28, 2025, 9:17:00 AM