Credentialing Quality Specialist
Community Health Choice, Inc. (Community) is a non-profit managed care organization (MCO), licensed by the Texas Department of Insurance. Through its network of more than 10,000 providers and 94 hospitals, Community serves over 400,000 Members with the following programs:
• Medicaid State of Texas Access Reform (STAR) program for low-income children and pregnant women
• Children’s Health Insurance Program (CHIP) for the children of low-income parents, which includes CHIP Perinatal benefits for unborn children of pregnant women who do not qualify for Medicaid STAR
• Health Insurance Marketplace Plans that offer individual health coverage that includes preventive care, emergency services, prescription drugs, and hospitalization available to all, regardless of pre-existing conditions.
Improving Members' experiences is at the heart of every Community position. We strive every day to make sure that our Members have access to the high-quality health care they need and deserve.
Community is accredited by URAC for its health plan operations. We offer care management programs for asthma, diabetes, and high-risk pregnancy. An affiliate of the Harris Health System (Harris Health), Community is financially self-sufficient and receives no financial support from Harris Health or from Harris County taxpayers.
Under the direction of the Credentialing Manager, the Credentialing Quality Specialist (CQS) is responsible for performing a quality analysis of the credentialing files and data received from state-mandated credentialing verification organization (CVO) for completion and accuracy prior to submitting for approval by the Medical Care Management Committee. Additionally, the candidate will conduct all aspects of credentialing delegation oversight, including pre-delegation and annual delegated credentialing audits.
The Credentialing Quality Specialist will perform duties related to data analysis of the credentialing database and provider directory to ensure quality and accuracy, and assist in the development of departmental data analysis tools.
The candidate will assist in the development of measurable quality standards for database and provider directory integrity and make recommendations to achieve departmental metrics and goals.
- High School graduation.
- National Association of Medical Staff Services Certification (NAMSS) such as Certified Provider Credentialing Specialist (CPCS) or Certified Professional in Medical Services Management (CPMSM) preferred.
- Four years of healthcare practitioner credentialing experience and at least one year of data quality analysis experience is required.
- Writing /Composing/Correspondence/Reports
- Analytical, Mathematics, Medical Terms, Research, Statistical
- MS Word, MS Excel
Benefits and EEOC
Community employees’ benefits are provided by Harris Health. These benefits are designed to provide you with flexibility and choices in meeting your specific needs.
Community is an Equal Opportunity Employer.