Credentialing Specialist

About the role

As a Credentialing Professional, you will be responsible for coordinating the credentialing, re-credentialing, and payer enrollment process for providers in accordance with delegated credentialing agreements, policies and procedures, industry best practices, and regulatory requirements. You will manage daily credentialing operations, including resolution of non-responsive providers, and work collaboratively with clinic managers and the hospital medical staff office to ensure timely completion of the delegated credentialing and re-credentialing process. Success requires a comprehensive understanding of credentialing regulations and processes, strong organizational and communication skills, and the ability to manage complex administrative tasks to ensure provider compliance and efficient operational flow. St. Joseph Health has been serving the Brazos Valley since 1936 (Bryan/College Station, Navasota, Caldwell, Madisonville, TX) and operates a Level III Trauma Center, the first Joint Commission‑certified Primary Stroke Center, the first accredited Chest Pain Center in the region, and is a leader in critical care and cardiovascular services. The system includes over 100 employed providers and more than 30 ambulatory clinics offering primary care, express care, and imaging/diagnostic services.

Responsibilities

• Coordinating the credentialing, re-credentialing, and payer enrollment process for providers in accordance with delegated credentialing agreements, policies and procedures, industry best practices, and regulatory requirements.
• Managing daily credentialing operations, including resolution of non‑responsive providers.
• Working collaboratively with various clinic managers and the hospital medical staff office to ensure the successful and timely completion of the delegated credentialing and re‑credentialing process.
• Demonstrating a comprehensive understanding of credentialing regulations and processes, possessing strong organizational and communication skills, and effectively managing complex administrative tasks to ensure provider compliance and efficient operational flow.
• Managing the process of sending initial and/or reappointment applications and monitoring their return with required documents.
• Processing appointment/reappointment applications accurately, thoroughly, and timely; clearly and succinctly communicating reappointment status to applicants in writing.
• Filing appointment/reappointment applications and other communication as needed.
• Preparing files and other documents, as requested, for review and evaluation of the clinical Service Chief and