Manager, Credentialing & Provider Enrollment

We are searching for a Centralized Credentialing Manager - someone who works well in a fast-paced setting. In this position, you'll be responsible for maintaining the Practitioner and Facility Credentialing Program for Texas Children''s Medical Staff and Texas Children''s Physician Group (TCPSO). This role will be primarily responsible for maintaining policies and processes in compliance with all applicable federal, state, and nationally recognized regulatory and/or accrediting bodies, and overseeing credentialing staff in the preparation of all credential files and reports to ensure compliance.

Think you've got what it takes?

Job Duties & Responsibilities

• Manages a Credentialing Program that meets regulatory and accrediting body requirements
• Responsible for Credentialing responses to regulatory audits
• Responsible for training of Texas Children's Centralized Credentialing staff to ensure a comprehensive, up to date knowledge base for identifying potential quality, regulatory, or malpractice issues early in credentialing process
• Responsible for credentialing and re-credentialing functions for practitioners seeking to join the Texas Children's Medical Staff and/or become a member of the TCPSO through direct credentialing
• Oversees credentialing and re-credentialing functions for practitioners privileged through the Texas Credentials Committee or approved as a member of the TCPSO accessing payor's delegated agreements
• Maintains a current and accurate database of all credentialed practitioners
• Ensures that the credentialing and reappointment process for the Medical Staff follow Joint Commission (TJC) requirements as outlined in the TCH Bylaws and Rules and Regulations and understand the linkage between your department's requirements and those of the integrated delivery system
• Ensures that NCQA requirements specific to the TCPSO Credentialing program are fulfilled and understands the linkage between the TCH Centralized Credentialing department's requirements and those of the integrated delivery system
• Collaborates with colleagues in other departments to ensure all NCQA and TJC requirements are met

Skills & Requirements

• High School Diploma or GED is required; Associate's or Bachelor's degree is preferred
• A Bachelor's degree may substitute for 4 years and an Associate's degree may substitute for 2 years
• Certified Professional Medical Services Management or Certified Provider Credentialing Specialist license is preferred
• 8 years experience in a healthcare delivery environment, hospital, physician practice, physician billing, credentialing, managed care, provider engagement, and/or privileging environment required
• Previous supervisory or managerial experience highly desired

Highly Desired Skills/Knowledge: Revenue Cycle, Revenue Cycle Analyst, Billing, Coding

Since 1954, Texas Children's has been leading the charge in patient care, education and research to accelerate health care for children and women around the world. When you love what you do, it truly shows in the smiles of our patient families, employees and our numerous accolades such as being consistently ranked as the best children's hospital in Texas, and among the top in the nation by U.S. News & World Report as well as recognition from Houston Business Journal as one of this city's Best Places to Work for ten consecutive years.

Texas Children's comprehensive health care network includes our primary hospital in the Texas Medical Center with expertise in over 40 pediatric subspecialties; the Jan and Dan Duncan Neurological Research Institute (NRI); the Feigin Tower for pediatric research; Texas Children's Pavilion for Women, a comprehensive obstetrics/gynecology facility focusing on high-risk births; Texas Children's Hospital West Campus, a community hospital in suburban West Houston; Texas Children's Hospital The Woodlands, the first hospital devoted to children's care for communities north of Houston; and Texas Children's Hospital North Austin, the new state-of-the-art facility providing world-class pediatric and maternal care to Austin and Central Texas families. We have also created Texas Children's Health Plan, the nation's first HMO focused on children; Texas Children's Pediatrics, the largest pediatric primary care network in the country; Texas Children's Urgent Care clinics that specialize in after-hours care tailored specifically for children; and a global health program that is channeling care to children and women all over the world. Texas Children's Hospital is affiliated with Baylor College of Medicine, one of the largest, most diverse and successful pediatric programs in the nation.

To join our community of 15,000+ dedicated team members, visit texaschildrenspeople.org for career opportunities.

Texas Children's is proud to be an equal opportunity employer. All applicants and employees are considered and evaluated for positions at Texas Children''s without regard to mental or physical disability, race, color, religion, gender, national origin, age, genetic information, military or veteran status, sexual orientation, gender identity, marital status or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.