IMCS Group · 4 months ago
Temp - Administrative - Credentialing Specialist (Days) Dallas, TX
Dallas, TX
Full-time
Hybrid
New Grad, Entry LevelIMCS Group is seeking a Credentialing Specialist to support the credentialing program at Parkland Community Health Plan. The role involves ensuring compliance with regulatory requirements and conducting evaluations of practitioners and facilities within the PCHP network.
Staffing & Recruiting
Responsibilities
Builds and maintains relationships with external vendors and credentialing partners including Aperture & Texas Association of Health Plans
Administrates reports in external database portals & analyze data, confirm accuracy, and present to internal department
Assists with the oversight of the delegated and non-delegated provider and facility’s data
Gathers, analyzes, and reports provider data to internal and external customers
Ensures that all practitioners and facilities are evaluated upon entry into the PCHP network and conducts an ongoing review of the providers
Identifies opportunities for improvement through the audit process and provide recommendations
Accurately tracks, reports, and follows up on the status of credentialing applications
Maintains a strict degree of confidentiality in all areas relating to provider credentials, status and provider personal information
Familiar with state specific all credentialing department policies and procedures
Assist with miscellaneous audits projects throughout the year as required
Communicates with Credentialing Manager regarding any or all credentialing delays or issues
Other duties as assigned
Identifies ways to improve work processes and improve customer satisfaction. Makes recommendations to supervisor, implements, and monitors results as appropriate in support of the overall goals of PCHP
Stays abreast of the latest developments, advancements, and trends in the field by attending seminars/workshops, reading professional journals, actively participating in professional organizations, and/or maintaining certification or licensure. Integrates knowledge gained into current work practices
Maintains knowledge of applicable rules, regulations, policies, laws and guidelines that impact the area. Develops effective internal controls designed to promote adherence with applicable laws, accreditation agency requirements, and customer requirements. Seeks advice and guidance as needed to ensure proper understanding
Qualification
Required
Access to high-speed internet and secure working environment is required
Applicant must have the necessary equipment for the contract; 2 monitors, keyboard, mouse, web camera
Supports the credentialing program that implements federal, state and local regulatory and NCQA accreditation requirements
Ensures that all practitioners and facilities are evaluated upon entry into the PCHP network and conducts an ongoing review of the providers
Gathers, analyzes, and report provider data for the provider directory, billing needs, and member support
Communicates with providers and provider groups to answer their questions and concerns or direct to the proper department
Assists with oversight audits of delegated and non-delegated providers
Builds and maintains relationships with external vendors and credentialing partners including Aperture & Texas Association of Health Plans
Administrates reports in external database portals & analyze data, confirm accuracy, and present to internal department
Assists with the oversight of the delegated and non-delegated provider and facility's data
Accurately tracks, reports, and follows up on the status of credentialing applications
Maintains a strict degree of confidentiality in all areas relating to provider credentials, status and provider personal information
Familiar with state specific all credentialing department policies and procedures
Communicates with Credentialing Manager regarding any or all credentialing delays or issues
Identifies ways to improve work processes and improve customer satisfaction
Stays abreast of the latest developments, advancements, and trends in the field by attending seminars/workshops, reading professional journals, actively participating in professional organizations, and/or maintaining certification or licensure
Maintains knowledge of applicable rules, regulations, policies, laws and guidelines that impact the area
Develops effective internal controls designed to promote adherence with applicable laws, accreditation agency requirements, and customer requirements
Preferred
Local candidates preferred; ***/hr rate within *** miles
Non local candidates; ***/hr rate outside of 35 miles and would be considered fully remote
Company
IMCS Group
IMCS Group is an IT, Healthcare, and Professional Staffing Company that helps Enterprises optimize the business value of their Staffing investments and enables them to achieve world-class business performance.
Founded in 2002
201-500 employees
H1B Sponsorship
IMCS Group has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (11)
2024 (16)
2023 (33)
2022 (32)
2021 (47)
2020 (82)
Funding
Current Stage
Growth StageLeadership Team
Satish G Kumar
Founder and CEO
Kathleen Thompson
Diretor Client Partnership
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