Credentialing Specialist

• Coordinate all activities associated with credentialing and re-credentialing of physicians and providers
• Ensure credentialing policies and procedures meet organizational, state regulatory, and external accreditation requirements
• Implement and monitor procedures related to credentialing, re-credentialing, and privileging of network providers
• Process provider applications and re-applications, including initial mailing, review, and database loading
• Lead training initiatives for less experienced specialists
• Participate in proctoring credentialing exams
• Conduct regular file audits
• Maintain the provider profiling system
• Communicate with providers by phone and mail regarding credentialing status
• Provide guidance or expertise to less experienced specialists
• Serve as a liaison during credentialing processes
• Assist in managing credentialing policies, procedures, and provider delegation maintenance
• Ensure compliance with Memorial Hermann policies, procedures, standards, budgetary specifications, time management, supply management, productivity, and quality of service
• Support department-based goals and serve as a preceptor, mentor, and resource to less experienced staff
• Model Memorial Hermann service standards and provide safe, caring, personalized, and efficient experiences
• Perform other duties as assigned

Senior Credentialing Specialist – Hybrid

• Work closely with the local market onboarding team on all new providers in the pipeline.
• Request credentialing data and supporting documents from physicians.
• Communicate physician-related delays that may jeopardize project timelines.
• Prepare and/or update provider CAQH applications for newly affiliated and existing healthcare providers.
• Communicate newly affiliated providers to health plans to initiate TIN changes, demographic flips, or credentialing.
• Establish credentialed status to facilitate billing.
• Maintain credentialing databases and up-to-date file process tracking.
• Execute standard operating procedures and communicate issues, trends, and concerns to the Regional Supervisor.
• Identify process improvement opportunities and work with the Regional Supervisor on payor-related challenges.
• Complete workflow items within required turnaround times and quality expectations.
• Resolve billing and collections issues for services rendered.
• Educate internal markets on payor contractual obligations, authorizations, billing requirements, and operational procedures.
• Provide credentialing information to Market Operations.
• Perform data entry, initial credentialing or recredentialing per NCQA, health plan submissions, and UCC credentialing.

Senior Credentialing Specialist, TPR

• Manage full-cycle credentialing and re-credentialing activities for clinical and ancillary providers
• Conduct primary source verification of licensure, education, training, certifications, and employment history
• Collect, review, and maintain credentialing documentation and provider files
• Upload and maintain documentation in the MD-Staff-approved credentialing software system
• Conduct NPDB queries, sanctions checks, background checks, and other required screenings
• Prepare and submit credentialing packets to military treatment facilities and applicable governing or oversight organizations
• Coordinate provider privileging and appointment processes with military treatment facility personnel and other stakeholders
• Track licenses, certifications, and expirable credentials to ensure timely renewals and continued compliance
• Communicate with providers and third-party organizations to obtain missing or incomplete documentation
• Conduct periodic audits of credentialing files for accuracy, completeness, and compliance
• Collect, analyze, and report credentialing data and compliance metrics
• Prepare reports on credentialing status, timelines, and compliance
• Identify process improvement opportunities and make recommendations
• Remain current on credentialing requirements, regulations, standards, and best practices
• Perform other duties as assigned