Senior Managed Care Credentialing Specialist - (Museum District)

At Houston Methodist, the Senior Managed Care Credentialing Specialist is responsible for leading and executing complex credentialing and payer enrollment activities, ensuring compliance with regulatory standards and payer requirements. This senior-level role mentors' junior staff, supports the onboarding and training of new team members, and provides subject matter expertise in managed care credentialing. The Senior Specialist also plays a pivotal role in special initiatives, including technology implementations and establishing new payer delegation arrangements, while maintaining a high level of accuracy, timeliness, and collaboration across departments.

Requirements:

Qualifications:

LICENSES AND CERTIFICATIONS - REQUIRED

• N/A

LICENSES AND CERTIFICATIONS - PREFERRED

• CPMSM - Certified Professional Medical Services Management (NAMSS) OR
• CPCS - Certified Provider Credentialing Specialist (NAMSS)

KNOWLEDGE, SKILLS, AND ABILITIES

• Demonstrates the skills and competencies necessary to safely perform the assigned job, determined through ongoing skills, competency assessments, and performance evaluations

• Sufficient proficiency in speaking, reading, and writing the English language necessary to perform the essential functions of this job, especially with regard to activities impacting patient or employee safety or security

• Strong interpersonal and communication skills to engage effectively with internal stakeholders, health plans, and providers, using a service-oriented and solutions-focused approach

• Proven ability to lead, mentor, and train junior staff, fostering professional development and team collaboration

• Excellent organizational and time management skills, with the ability to independently manage multiple priorities and high-volume credentialing activities

• Demonstrates strong attention to detail and a commitment to accuracy, ensuring high-quality documentation and data integrity

• Proficient in the use of credentialing software systems and intermediate to advanced skills in Microsoft Office Suite (Word, Excel, Outlook, Teams)

• Ability to analyze and interpret regulatory, payer, and organizational requirements and apply them effectively to credentialing processes

• Skilled in identifying process improvement opportunities and participating in implementation of new tools, workflows, or systems

• Demonstrates initiative and accountability in completing tasks and contributing to departmental goals, while maintaining a commitment to continuous learning and growth

SUPPLEMENTAL REQUIREMENTS

WORK ATTIRE

• Uniform No
• Scrubs No
• Business professional Yes
• Other (department approved) No

ON-CALL*
*Note that employees may be required to be on-call during emergencies (ie. DIsaster, Severe Weather Events, etc) regardless of selection below.

• On Call* No

TRAVEL**
**Travel specifications may vary by department**

• May require travel within the Houston Metropolitan area No
• May require travel outside Houston Metropolitan area No

Company Profile:

Houston Methodist Specialty Physician Group is an integral part of Houston Methodist’s overall strategy to become one of the nation’s leading academic medical centers. Established as a nonprofit corporation certified by the Texas State Board of Medical Examiners, the Specialty Physician Group enables physicians to maintain autonomy with respect to clinical practice while growing their practice within an academic environment.

Houston Methodist is an Equal Opportunity Employer.