Assistant Manager, Credentialing
- Job Title
- Assistant Manager, Credentialing
- Job ID
- HOUSTON, TX 77030
- Other Location
Do you desire a rewarding role with a great organization?
Do you want a job that's not just a job?
Seeking job fulfillment in a position that will make an impact on others' lives?
If so, we want to hear from you!
UT Physicians is committed to providing the best that medicine has to offer with quality care that incorporates the latest medical treatments and innovations and the most up-to-date technology.
With more than 1,500 physicians certified in 80 medical specialties and subspecialties, UT Physicians is a prestigious organization located in the Houston Medical Center and surrounding areas providing multi-specialty care for the entire family. We help patients needing urgent, highly specialized or complex care and also provides high-quality, wellness-oriented primary care for routine illnesses and maintenance of good health.
Our doctors are internationally recognized for leading-edge medical research and treatment. Many are among the Woodward-White “Best Doctors in America.” They are national leaders in research, education and clinical excellence.
We are currently looking for Healthcare professionals to join our team.
Assists the Manager of Credentialing and Provider Relations in planning, coordinating, and directing the business management and administrative activities for the credentialing and provider service functions of the department. Coordinates and monitors the primary source verification process for all contracted physicians and allied health professionals.
- Assists the Manager of Credentialing and Provider Relations with all credentialing and delegated credentialing functions.
- Provide oversight and guidance to the Credentialing team to assure all timelines, accuracy of data and work processes are met. Assure all Federal and state reporting requirements are met.
- As assigned by the Manager, performs pre-delegation and annual delegation oversight audits by the managed care payers, ensuring the overall areas for delegation are functional and in compliance with the plan's regulatory contracts.
- Demonstrate commitment to the ACT-IT philosophy and assists in the accomplishment of UTP goals. Performs duties in a manner to promote quality patient care and customer service/satisfaction.
- Maintains confidentiality per HIPAA guidelines in regard to patient information.
- Assists the Manager in credentialing, provider service, business management, and administrative activities which include fiscal and budgetary affairs, personnel matters, operational systems, and other activities essential to the effective operations.
- Assumes responsibility for the day-to-day operational management of personnel, equipment to assure the smooth operation of the credentialing and provider service functions of the department in the Manager’s absence.
- Has a strong knowledge and understanding of the healthcare industry with a high degree of comfort in handling issues related to managed care.
- Has a full understanding and ability to apply NCQA regulatory standards for both quality and credentialing ensuring complete compliance with regulations at all times.
- Has frequent contacts with faculty members of the University and maintains work relationships within the Health Science Center, University, and contacts outside U.T Physicians as they relate to the department’s functions of credentialing and provider services.
- Internally, the incumbent develops professional relationships with his/her peers, superiors, and their subordinates.
- Responsible for maintaining and ensuring accurate information regarding the participant status with contracts of UTP and that such providers in the network are properly represented.
- Responsible for the administrative maintenance of the UTP provider network ensuring compliance with contractual obligations as they pertain to the network.
- Assists the Manager in reviewing contracts regarding delegated credentialing and provider service functions ensuring compliance is met.
- Responsible for keeping up-to-date with current regulations from TDI,CMS and NCQA as they relate to provider service and credentialing functions.
- Assists with developing statistical data of network physicians for monthly reporting to payors.
- Is able to recognize and prioritize problems that occur frequently. Incumbent must be able to deal with diverse situations and make judgment decisions as to proper course of action within departmental guidelines and policy. Has the ability to coordinate office activities, to respond to various inquiries from other management and staff, and to interact effectively with personnel from the University.
- Assists the Manager to ensure practices and procedures are accurate and up-to-date with industry trends and current credentialing standards.
- Assists in the accomplishment of UTP company goals and embraces the ACTIT philosophy.
- Any other related duties as assigned by your supervisor/manager.
- Bachelor’s degree (B.A.) from four-year college or university; or one to two years related experience and/or training; or equivalent combination of educations and experience.
- Medical Credentialling Experience required.
- Knowledge of NCQA, TDI, and CMS standards required.
- Prior Supervisory/team leadership skills required.
- Excellent project management skills.
- Excellent Communication Skills.
- Microsoft Office (including Outlook, Word, Excel, and Powerpoint)
- Medical Database Experience
- ECHO or any similar credentialling software experience required
In exchange for your dedication, you can expect a competitive salary, sincere appreciation for your work and a beautiful, "family-like" working environment unlike any other. We offer a competitive salary along with a comprehensive benefits package that includes Paid Time Off, Medical, Dental, Vision and a 401-K Retirement matching. We value our employees’ time and efforts. Plus, we work to maintain the best possible environment for our employees, where people can learn and grow with the company. We strive to provide a collaborative, creative environment where each person feels encouraged to contribute to our processes, decisions, planning, and culture.