The Credentialing Coordinator Utilizes knowledge of credentialing/re-credentialing principles, NCQA Standards, legal principles of credentialing, credentialing and managed care terminology, and management of credentialing information in the review of practitioners credentialing/re-credentialing applications. Utilizes computer and data organizational skills to support the credentialing functions of DMPN and to populate and maintain the DMPN credentialing. Responsible for data integrity, accuracy, and consistency of practitioners' information in DMPN's database.
Your Job Requirements:
Some college or college degree preferred but not required.
Certified Provider Credentialing Specialist (CPCS) or Certified Medical Staff Coordinator (CMSC) preferred but not required.
Experience in using Windows and various software applications including databases, Excel spreadsheets, and graphics.
Intermediate to advanced level of proficiency in computer skills using Microsoft Office.
Experience in scanning documents into a personal computer. Multitasking skills.
Work Experience: 3-4 years experience
Your Job Responsibilities:
Responsible for tracking and obtaining current expirables for practitioners.
Responsible for Medicare and Medicaid enrollment for employed practitioners.
Demonstrates knowledge of DMPN's Credentialing Plan and Guidelines; ongoing monitoring; credentialing standards for NCQA and TDI including Texas Administrative Codes pertaining to credentialing.
Inputs credentialing data and maintains the accuracy and completeness of the fields in the DMPN database.
Responsible for gathering DMPN credentialing/recredentialing documents and information; performs primary verification of credentialing information; reviews and analyzes the documentation for completeness and consistency; follows up on applications that are incomplete. Prepares completed files for review and approval by the DMPN Credentialing Committee and/or Chairman.
Responsible for setting up electronic credentialing file for each practitioner and scanning and/or filing hard copies of credentialing documents into practitioners electronic or hard copy files.
Responsible for completing and maintaining accurate and current information in employed practitioners' CAQH profiles.
Methodist Health System is comprised of four thriving hospitals serving the southern perimeter of the Dallas and Fort Worth Metroplex. Methodist Dallas Medical Center is one of Dallas' finest and largest not-for-profit hospitals. This 515-bed major teaching and referral facility is the flagship hospital for Methodist Health System. Located just 10 minutes away, Methodist Charlton Medical Center is a modern 269-bed facility located in the suburbs of Southwest Dallas County. Opened in December of 2006, Methodist Mansfield Medical Center is a state-of-the-art 168 bed, full-service hospital located in Mansfield, TX south of Arlington and Fort Worth in Tarrant County. Methodist Richardson Medical Center, a 205-bed acute care hospital, serves residents of Richardson, Plano, North Dallas and the surrounding communities. Additionally, Methodist Family Health Centers have been established to better meet healthcare needs in the outlying communities.