Credentialing Specialist II

#### About Us

Here at Baylor Scott \& White Health we promote the well\-being of all individuals, families, and communities. Baylor Scott and White is the largest not\-for\-profit healthcare system in Texas that empowers you to live well.

Our Core Values are:

• We serve faithfully by doing what's right with a joyful heart.
• We never settle by constantly striving for better.
• We are in it together by supporting one another and those we serve.
• We make an impact by taking initiative and delivering exceptional experience.

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#### Benefits

Our benefits are designed to help you live well no matter where you are on your journey. For full details on coverage and eligibility, visit the Baylor Scott \& White Benefits Hub to explore our offerings, which may include:

• 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 1

Note: Benefits may vary based upon position type and/or level.

#### Job Summary

Under general supervision, responsible for all functions of the Credentialing Specialist.

• This includes credentialing, re\-credentialing, and clinical privileging of medical staff.
• It also involves delineation of services for allied health professionals at Baylor Scott \& White Health.
• Responsible for the accuracy and integrity of the credentialing and clinical privileging database system.
• Functions as a Credentialing Specialist to ensure the department performs optimally.
• Is knowledgeable about TJC, CMS, NCQA and other regulatory agencies related to medical staff and allied health professionals.

Work Model

• Week One, Day One

+ BSWH Virtual Orientation

• Day Two \- Day Ten

+ Credentialing Specialist Onsite training

• If onsite training is successful, schedule will move to Hybrid

+ (2\) Days on site, (3\) Days at home

• At 6 weeks, skillset will be evaluated to determine if full\-time remote is an option

+ With the exception of the monthly in\-person team meetings.

#### Essential Functions of the Role

• Coordinates and maintains credentialing and re\-credentialing for new and reappointment applications.
• Manages clinical privileging for medical staff and allied health professionals.
• Ensures compliance with medical staff bylaws, rules, regulations, policies, TJC, CMS standards, NCQA and other regulatory agencies.
• Processes and maintains confidential medical staff and allied health professional data files.
• Handles requests for new applications, reappointment applications, staff category changes, and resignations or retirement.
• Obtain all applicable affiliations and education using verification software, databases, and approved internet sites for primary source information and references.
• Sends appropriate communication and provides follow up to practitioners.
• Reviews privilege cards and helping documentation for accuracy and completion.
• Record all incoming mail/helping documentation in credentialing software system.
• Performs quality audit and review.

+ This may include examining files for completeness, conducting a final audit of completed applications and privileges, and confirming checklist data entry is complete.

• Provides final follow\-up as necessary.
• Communicates incomplete status with applicants, facilities, and CVS Leadership.
• Maintains data integrity of the credentialing software database according to established policies and procedures.
• Maintains knowledge of medical staff bylaws, rules, regulations, and allied health policies.
• Knows about other credentialing policies and procedures.
• Acts as a liaison between the medical staff facilities, practitioners, allied health professionals and administration.
• Performs other duties as required.

+ Job duties are subject to changes as directed by management.

#### Key Success Factors

• Associate's degree preferred.
• Knowledge of Health Line System (Medical Staff Line and/or Echo), MD\-Staff or other credentialing system preferred.
• Knowledge of basic anatomy and physiology, medical terminology and functions of medical staff services.
• Advanced computer skills in word processing, spreadsheets and databases.

#### Belonging Statement

We believe that all people should feel welcomed, valued and supported.

QUALIFICATIONS

• EDUCATION \- Associate's or 2 years of work experience above the minimum qualification
• EXPERIENCE \- 1 Year of Experience

+ Experience with MD\-Staff a plus

+ Experience and knowledge of NCQA guidelines a plus

CERTIFICATION/LICENSE/REGISTRATION \-

• Requires one of these certifications

+ Cert Professional Medical Services Management (CPMSM)

+ Cert Medical Staff Coord (CMSC)

+ Cert Provider Credentialing Specialist (CPCS).