Credentialing Specialist-Hybrid/local - Kelsey-Seybold Clinics - Pearland, TX 2376342 | Pearland, Texas | Kelsey-Seybold Clinic

Credentialing Specialist

Explore opportunities with Kelsey-Seybold Clinic, part of the Optum family of businesses. Work with one of the nation's leading health care organizations and build your career at one of our 40+ locations throughout Houston. Be part of a team that is nationally recognized for delivering coordinated and accountable care. As a multi-specialty clinic, we offer care from more than 900 medical providers in 65 medical specialties. Take on a rewarding opportunity to help drive higher quality, higher patient satisfaction and lower total costs. Join us and discover the meaning behind Caring. Connecting. Growing together.

The Credentialing Specialist will be responsible for the credentialing and recredentialing of all employed Kelsey-Seybold physicians and contracted affiliated providers. The functions include but are not limited to initial and recredentialing applications, mailing and tracking of all applications, primary source verifications, file production and maintenance, presentation at Credentialing Committee, internal and external communication of outcome reporting, liaison with designated payors regarding the delegation of credentialing/recredentialing to Kelsey-Seybold (initial assessments, onsite audits, corrective action plans and submission of monthly reports), hospital privileges, assist with credentialing subdelegations and tracking of licensure/certification expirations.

Primary Responsibilities:

• 10% Mailing and tracking of all applications
• 20% Primary source verification of licensures, work history, malpractice coverage and history, hospital privileges, FSMB, NPDB, ABMS, etc.
• 20% Create and maintain credentialing/recredentialing and correspondence files
• 5% Perform monthly license/certificate verifications (obtain copies)
• 5% Presentation of files at Credentialing Committee and maintenance of committee meeting minutes
• 5% Internal and external communication of outcome of committee's approval/denial of provider
• 5% Hospital Privileges
• 20% Liaison with designated payors regarding the delegation of credentialing/recredentialing to Kelsey-Seybold including: initial assessments, ongoing onsite audits, assist with corrective action plans and submission of monthly reports)
• 5% Assist with subdelegations
• 5% Other duties as assigned

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

• High school diploma or equivalent
• 2+ years Credentialing experience with hospital application experience or managed care experience
• Proficient: Microsoft Access, Word and Excel
• Proven capable of sitting for extended periods of time

Preferred Qualifications:

• College Degree, Certification
• Knowledge of AAAHC, NCQA and TDI credentialing standards, Midas Seeker
• Proven self starter who can work independently with minimal supervision

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The hourly pay for this role will range from $18.00 - $32.00 per hour based on full-time employment. We comply with all minimum wage laws as applicable.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. OptumCare is an Equal Employment Opportunity employer and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status.

OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.