Responsible for leading, coordinating, monitoring, and maintaining the credentialing expireables process. Ensures interpretation and compliance with the appropriate accrediting and regulatory agencies, while developing and maintaining a working knowledge of the statues and laws relating to credentialing. Responsible for the accuracy and integrity of data within the credentialing database.
Conducts thorough investigation, research, and primary source verification of all expireables.
Identifies issues that require additional investigation and evaluation, validates discrepancies, and ensures appropriate follow-up.
Prepares and sends monthly expireables reports to clients.
Responds to inquiries from other healthcare organizations, interfaces with internal/ external customers on day-to-day expireables issues as they arise.
Meets weekly performance metrics which includes: amount of expireables completed and data integrity.
Utilizes and maintains the credentialing database, optimizing efficiency, and performs queries, reports, and document generation.
Monitors the initial, reappointment, and expireables process for practitioners, ensuring compliance with regulatory bodies (Joint Commission, NCQA, URAC, CMS, Federal/State), bylaws, policies/procedures, and delegated agreements
Maintains strict confidentiality of all data and information.
Performs miscellaneous job-related duties as assigned.
High School Diploma or GED
Minimum of at least one (1) year experience related to hospital or managed care credentialing.
CHRISTUS HEALTH is an international Catholic, faith-based, not-for-profit health system comprised of almost more than 600 services and facilities, including more than 60 hospitals and long-term care facilities, 350 clinics and outpatient centers, and dozens of other health ministries and ventures. CHRISTUS operates in 6 U.S. states, Colombia, Chile and 6 states in Mexico. To support our health care ministry, CHRISTUS Health employs approximately 45,000 Associates and has more than 15,000 physicians on medical staffs who provide care and support for patients. CHRISTUS Health is listed among the top ten largest Catholic health systems in the United States.