Careers At Legacy Community Health Services

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Credentialing Specialist

Department: Billing
Location: Houston, TX

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 at 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 with FQHC and third-party insurance standards.

 
Essential Functions

  • 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 address/corrects discrepancies as requested by payors.
  • Conduct all follow-up steps until payor approval/completion is obtained.
  • File provider practice changes notifications and performs 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 of 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.
  • 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 with 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.
  • Performs other duties as assigned.

 
Education & Training Requirements

  • High School Diploma or GED
  • Bachelor’s College Degree preferred

 
Work Experience Requirements

  • At least five (5) years’ experience in capacity as credentialing coordinator or credentialing specialist
  • Have good working knowledge of guidelines and requirements of agencies and carriers
  • Must have strong, clear communication skills
  • Detailed oriented and strong organizational skills required

Benefits

  • 9 Holiday + 1 Floating Holiday
  • PTO
  • 403b Retirement Plan
  • Medical / Vision / Dental (if eligible)

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