Legacy Community Health is a premium, Federally Qualified Health Center (FQHC) that provides comprehensive care to community members regardless of their ability to pay. Our goal is to treat the entire patient while improving their overall wellness and quality of life, in addition to providing free pregnancy tests, HIV/AIDS screening. At Legacy, we empower patients to lead better lives by promoting healthy behaviors and offering resources such as literacy classes, family planning services, and nutrition and weight management information.
Our roots began in 1981 as the Montrose Clinic, with specialization in HIV education, testing, and treatment. Since then, the agency has expanded to 10 clinics in Houston, one in Baytown, two in Beaumont, and one in Deer Park with extensive services that include: Adult primary care, HIV/AIDS care, pediatrics, OB/GYN and maternity, dental, vision and behavioral health. We also service students within KIPP and YES Prep schools. Legacy is committed to driving healthy change in our communities.
Job Description
The Credentialing Specialist will conduct all aspects of third party credentialing for providers and facilities in accordance to FQHC and third party insurance standards.
Essential functions are those tasks, duties, and responsibilities that comprise the means of accomplishing the job’s purpose and objectives. Essential functions are critical or fundamental to the performance of the job. They are the major functions for which the person in the job is held accountable.
• Prepare and maintain credentialing files and reports for all individual providers including maintenance of credentialing software, provider rosters and spreadsheets to comply with group delegation requirements.
• Process and file applications with third party payors according to each payors individual requirements and addresses/corrects discrepancies as requested by payors.
• Conduct all follow up steps till payor approval/completion is obtained.
• File provider practice change notifications and perform follow up duties till confirmed complete by payors.
• Update NPI records according to provider specifications.
• Enroll provider in Medicare/Medicaid as prescribed by each program requirements.
• Track provider licensure and Board expirations and ensures timely processing CAQH, TMHP and payor updates.
• Complete requests for re-credentialing for both providers and facilities.
• Accept and process all requests from payers for credentialing information/updates/new contracts and products
• Answer questions, process requests from staff/providers related to credentialing information.
• Prepare and maintain facility credentialing files and reports including maintenance of credentialing software, facility rosters and spreadsheets.
• Ensure all records meet standards set by carriers as well as FQHC guidelines
• Enrolls facilities in Medicare/Medicaid programs.
• Address enrollment disconnects in regards to facility and providers
• Assist with EHRS enrollment, tracking and filing
• Maintains quarterly payor specific rosters in accordance to CMS standards
• Assist in quarterly CAQH mass attestation
• Serves as liaison between Legacy and outside organizations and external customers.
• Participates in the Performance Improvement Program.
EDUCATION & TRAINING REQUIREMENTS
• Bachelor’s College Degree preferred
• At least five years’ experience in capacity as credentialing coordinator or credentialing specialist
• CPCS or CPMSM certification highly preferred or working towards certification(s)’
WORK EXPERIENCE REQUIREMENTS
• Have good working knowledge of guidelines and requirements of agencies and carriers
• FQHC credentialing experience is a plus
• Must have strong, clear communication skills
• Detailed oriented and organizational skills required
