Credentialing Specialist II

Credentialing Specialist

Here at Baylor Scott & White Health we promote the well-being of all individuals, families, and communities. Baylor Scott and White is the largest not-for-profit healthcare system in Texas that empowers you to live well.

Our Core Values are:

• We serve faithfully by doing what's right with a joyful heart.
• We never settle by constantly striving for better.
• We are in it together by supporting one another and those we serve.
• We make an impact by taking initiative and delivering exceptional experience.

Our benefits are designed to help you live well no matter where you are on your journey. For full details on coverage and eligibility, visit the Baylor Scott & White Benefits Hub to explore our offerings, which may include:

• Immediate eligibility for health and welfare benefits
• 401(k) savings plan with dollar-for-dollar match up to 5%
• Tuition Reimbursement
• PTO accrual beginning Day 1

Note: Benefits may vary based upon position type and/or level.

Under general supervision, responsible for all functions of the Credentialing Specialist.

• This includes credentialing, re-credentialing, and clinical privileging of medical staff.
• It also involves delineation of services for allied health professionals at Baylor Scott & White Health.
• Responsible for the accuracy and integrity of the credentialing and clinical privileging database system.
• Functions as a Credentialing Specialist to ensure the department performs optimally.
• Is knowledgeable about TJC, CMS, NCQA and other regulatory agencies related to medical staff and allied health professionals.

Work Model:

• Week One, Day One BSWH Virtual Orientation
• Day Two - Day Ten Credentialing Specialist Onsite training
• If onsite training is successful, schedule will move to Hybrid (2) Days on site, (3) Days at home
• At 6 weeks, skillset will be evaluated to determine if full-time remote is an option With the exception of the monthly in-person team meetings.

Essential Functions of the Role:

• Coordinates and maintains credentialing and re-credentialing for new and reappointment applications.
• Manages clinical privileging for medical staff and allied health professionals.
• Ensures compliance with medical staff bylaws, rules, regulations, policies, TJC, CMS standards, NCQA and other regulatory agencies.
• Processes and maintains confidential medical staff and allied health professional data files.
• Handles requests for new applications, reappointment applications, staff category changes, and resignations or retirement.
• Obtain all applicable affiliations and education using verification software, databases, and approved internet sites for primary source information and references.
• Sends appropriate communication and provides follow up to practitioners.
• Reviews privilege cards and helping documentation for accuracy and completion.
• Record all incoming mail/helping documentation in credentialing software system.
• Performs quality audit and review. This may include examining files for completeness, conducting a final audit of completed applications and privileges, and confirming checklist data entry is complete.
• Provides final follow-up as necessary.
• Communicates incomplete status with applicants, facilities, and CVS Leadership.
• Maintains data integrity of the credentialing software database according to established policies and procedures.
• Maintains knowledge of medical staff bylaws, rules, regulations, and allied health policies.
• Knows about other credentialing policies and procedures.
• Acts as a liaison between the medical staff facilities, practitioners, allied health professionals and administration.
• Performs other duties as required. Job duties are subject to changes as directed by management.

Key Success Factors:

• Associate's degree preferred.
• Knowledge of Health Line System (Medical Staff Line and/or Echo), MD-Staff or other credentialing system preferred.
• Knowledge of basic anatomy and physiology, medical terminology and functions of medical staff services.
• Advanced computer skills in word processing, spreadsheets and databases.

Qualifications:

• EDUCATION - Associate's or 2 years of work experience above the minimum qualification
• EXPERIENCE - 1 Year of Experience Experience with MD-Staff a plus Experience and knowledge of NCQA guidelines a plus

Certification/License/Registration:

• Requires one of these certifications or must obtain within 24 months from hire date:
• Cert Professional Medical Services Management (CPMSM)
• Cert Medical Staff Coord (CMSC)
• Cert Provider Credentialing Specialist (CPCS).

We believe that all people should feel welcomed, valued and supported.