Job details

Credentialing Specialist - Medical Group

JOB SUMMARYHybrid position - Dallas, TXUnder general supervision, accountable for all functions relating to the administrative work in coordinating credentialing and re-credentialing and the clinical privileging of the medical staff and delineation of services for the allied health professionals and others as appropriate for the Baylor Scott & White Health. Accountable for the accuracy and integrity of the credentialing and clinical privileging database system. Functions as a member of the team to assure optimum performance of the department. Provides information and guidance about medical staff/medical group bylaws/policies, medical staff/medical group rules and regulations, allied health professionals (AHP) policies, Joint Commission for Accreditation of Healthcare Organizations (JCAHO) and Center for Medicare and Medicaid Services (CMS), National Committee for Quality Assurance (NCQA) and other regulatory agencies as they pertain to medical staff/medical group and allied health professionals. Requires Medical Staff Services certification: Certified Professional Medical Services Management (CPMSM) or Certified Provider Credentialing Specialist (CPCS) or education plan to obtain in eighteen (18) months from date of hire.ESSENTIAL FUNCTIONS OF THE ROLE• Coordinates the credentialing, re-credentialing and clinical privileging process of new applications and reappointment applications to the medical staff and allied health professionals in compliance with the medical staff bylaws, medical staff/medical group policies and procedures, AHP policies, JCAHO, CMS, NCQA standards and other regulatory agencies including payer delegation agreements.• Processes confidential medical staff/medical group and allied health professional files requests for, but not limited to new applications, reappointment applications, temporary applications, more privileges, staff category changes, resignations / retirement.• Maintains data integrity of the credentialing and clinical privileging software system. According to established policies and procedures, accountable for the integrity of data• Obtains primary source information through utilization of verification software/ databases as well as approved verification sites via the Internet.• Ensures maintenance of medical staff/medical group and allied health professional files.• Ensures that results of medical staff/medical group quality management findings are provided to appropriate review committees/ departments and maintained in a confidential file.• Maintains a working knowledge of the medical staff/medical group bylaws, medical staff/medical group rules and regulations, allied health professional policies, as well as other policies and procedures pertaining to credentialing, etc.• Acts as a liaison between the medical staff/medical group, allied health professionals, nursing services and administration, practice operations and recruitment.• Performs other duties as required. Job duties are subject to changes as directed by management.• Accountable for recording and maintaining medical group credentialing status, clinical privileges for physicians and allied health staff members in the database.BENEFITSOur competitive benefits package includes the following• 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 1Note: Benefits may vary based on position type and/or levelQUALIFICATIONS• EDUCATION - Bachelor's• EXPERIENCE - 10 Years of Experience

Baylor Scott & White Health Glassdoor Company Review

3.8

Baylor Scott & White Health DE&I Review

No rating

CEO of Baylor Scott & White Health

Pete McCanna

Approve of CEO

Average salary estimate

Estimate provided by employer

$39 / HOURLY (est.)

min

max

$30

$48

If an employer mentions a salary or salary range on their job, we display it as an "Employer Estimate". If a job has no salary data, Rise displays an estimate if available.

What You Should Know About Credentialing Specialist - Medical Group, Baylor Scott & White Health

Are you ready to take on a pivotal role as a Credentialing Specialist at Baylor Scott & White Health in Dallas, TX? This hybrid position puts you at the heart of healthcare operations, where your expertise will help ensure that qualified medical professionals are credentialed and privileged correctly. In this role, you'll coordinate all activities related to the credentialing and re-credentialing of medical staff and allied health professionals, maintaining compliance with essential regulations such as JCAHO, CMS, and NCQA. Your attention to detail will be key as you ensure the accuracy and integrity of our credentialing database. You'll provide vital support and information regarding medical group policies and serve as a liaison between various departments. With your substantial experience, you’ll contribute to our team's optimum performance while continuously learning about evolving policies and best practices. As you work closely with healthcare professionals, you'll have the opportunity to impact patient care positively. We're looking for someone with a Bachelor's degree and a decade of experience, as well as a commitment to obtaining relevant certifications if you haven't done so already. Join us at Baylor Scott & White Health, where you’ll play a crucial role in quality healthcare delivery while enjoying competitive benefits from day one!

Frequently Asked Questions (FAQs) for Credentialing Specialist - Medical Group Role at Baylor Scott & White Health

What are the primary responsibilities of a Credentialing Specialist at Baylor Scott & White Health?

As a Credentialing Specialist with Baylor Scott & White Health, your main responsibilities will include coordinating the credentialing and re-credentialing processes, maintaining clinical privileging databases, ensuring compliance with medical staff bylaws, and acting as a liaison among medical staff, allied health professionals, and administration.