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Title:  Senior Credentialing Coordinator

Division:  Patient Business Services
Schedule:  Monday - Friday, 8:00 am - 5:00 pm
Work Location:  Houston, TX
Salary Range:  $46,176 - $63,723
FLSA Status:  Nonexempt
Requisition ID:  9394

Summary

The Senior Credentialing Coordinator performs credentialing activities to ensure the integrity and quality of practitioner credentialing and practice data. Will conduct thorough background investigations and compile profiles for practitioners applying for appointment/reappointment to BaylorMedCare. Will also process applications and perform data entry timely, accurately and in compliance with BaylorMedCare and National Committee for Quality Assurance (NCQA) standards, and perform these and other functions as necessary to meet departmental goals with only general supervision.

 

Internal Title: Senior Coordinator, Provider Support Services

 

Job Duties

  • Works with BCM Clinical Departments to identify practitioners and facilitate the Texas Standard Credentialing application process.
  • Applies independent decision-making to review and analyze physician applications and credentials for completeness and accuracy.
  • Performs background checks by contacting numerous primary sources. Contacts by written, verbal, or electronic means.
  • Maintains a system for follow-up of unanswered correspondence according to the schedules designed to maintain department standards for application processing time.
  • Compiles thorough practitioner profiles and prepares data for Committee review.
  • Maintains electronic and paper credentials files according to department standards.
  • Assists in the coordination of payer audits. Supplies auditors with data and other information to ensure department compliance with MCO standards.
  • Works cooperatively with team members to meet department goals and objectives with only general supervision.
  • Understands and complies with NCQA Standards as applicable to the Credentialing and related functions.
  • Understands and complies with BaylorMedCare Policies and Procedures.
  • Possesses exceptional written and verbal communication skills. 
  • Serves as an expert in Practitioner Credentialing Files.
  • Understands and complies with NCQA Standards as applicable to the Credentialing and related functions.


 

Minimum Qualifications

  • High school diploma or GED.
  • Four years of relevant experience.

Preferred Qualifications

  • Practitioner credentialing and managed care experience.
  • Three years' progressive responsibility within a healthcare administration environment. 
  • Knowledge of managed care practitioner credentialing, which include verification for State medical license, education, board certification, hospital affiliations, work history, National Practitioner Data Bank Query, other State and Federal sanction background queries, professional references, malpractice claims history and  must be familiar with the Texas Standard Credentialing Application and questions regarding inability to practice, illegal drug use, loss of license, felony conviction, loss or limited privileges. 

 

 

Baylor College of Medicine requires employees to be fully vaccinated -subject to approved exemptions-against vaccine-preventable diseases including, but not limited to, COVID-19 and influenza.

 

Baylor College of Medicine is an Equal Opportunity/Affirmative Action/Equal Access Employer.

 9394

CA