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 >50 clinics in Houston, one in Baytown, 3 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 Coordinator is responsible for the overall accuracy of the delegated rosters, for Medicare compliance roster attestations and serving as liaison between Legacy and outside organizations and external customers

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.
• Obtains and verifies credentialing documents required upon provider onboarding.
• Ensures compliance with the appropriate accrediting and regulatory agencies in relations to credentialing functions including application management and primary source verification. Conduct onboarding document request and primary verification source.
• Coordinates the management of the expirables process to ensure all contracted provider licenses and certificates remain current, ensuring appropriate notification prior to expiration Update and maintain CAQH records according to provider specifications.
• Revises general aspects of credentialing process as necessary; makes recommendations for changes in policies and procedures; assist in developing new process improvement strategies; maintains data integrity protocols and procedures
• Prepares for and coordinates credentialing audits in compliance with the managed care delegated credentialing contracts.
• Conduct file reviews to ensure documents meet credentialing standards and ensure all records meet standards set by carriers as well as FQHC guidelines
• Maintains quarterly payor specific rosters in accordance to CMS standards; conducts all follow up steps until payor approval/completion is obtained
• Assist in quarterly CAQH mass quarterly attestation
• Process and file applications with third party payors according to each payor’s individual requirements and addresses/corrects discrepancies as requested by payors.
• File provider practice change notifications and perform follow up duties till confirmed complete by payors.
• Enroll provider in Medicare/Medicaid as prescribed by each program requirements; Enrolls facilities in Medicare/Medicaid programs; Address enrollment disconnects in regards to facility and providers
• Complete requests for re-credentialing for both providers and facilities.
• Accept and process requests from payers for credentialing information/updates/new contracts and products
• Answer questions, process requests from staff/providers related to credentialing information.
• .Participates in the Performance Improvement Program.
• Performs other duties as assigned.

Education & Work Experience Requirements

• High School Degree
• Five (5) years experience in the capacity as credentialing coordinator or credentialing specialist specializing in provider enrollment.
• Strong Data Analysis experience preferred
• Have a good working knowledge of guidelines and requirements of agencies and carriers
• Must have strong, clear communication skills
• Detailed oriented and strong organizational skills required
• FQHC credentialing experience is a plus

Benefits

• Medical / Vision / Dental
• 9 Holiday + 1 Floating Holiday
• 403b Retirement Plan
• Paid Time Off (PTO)PTO Exchange benefit
• PTO Exchange will provide you with the option to convert a portion of your accrued but unused PTO hours for use toward several different benefits and causes, based on your own priorities.With PTO Exchange, you can convert a portion of your unused PTO into:
• 403(b) Retirement contributions
• Student loan payments / Tuition for the employee
• Leave Sharing donations to fellow employees

Job Type: Full-time

Pay: $48,000.00 - $65,000.00 per year

Benefits:

• Dental insurance
• Health insurance
• Paid time off
• Vision insurance

Schedule:

• 8 hour shift

Ability to commute/relocate:

• Houston, TX 77019: Reliably commute or planning to relocate before starting work (Required)

Experience:

• Microsoft Office: 1 year (Preferred)
• Microsoft Word: 1 year (Preferred)

Work Location: One location

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