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.

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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

•    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