Credentialing and Provider Enrollment Specialist

BayCare Health System; Florida; On-site; USD 55,000 - 75,000; Full time

Benefits offered by this job

Health insurance

Paid time off

Tuition reimbursement

401k match

Job summary

BayCare seeks a Credentialing and Provider Enrollment Specialist to support remote credentialing for physicians and providers while residing in Florida. This full-time role ensures alignment with NCQA, CMS, AHCA and state/federal guidelines.

You will verify primary sources, document verifications, maintain credentialing files, and assist renewals, collaborating with plans, the CBO and the Managed Care contracting department.

Qualifications

• High school diploma or GED required.
• Preferred associate or bachelor's degree.
• 1 year credentialing or 1 year managed care experience.
• CPCS certification preferred.

Responsibilities

• Initiate and maintain credentialing, managed care provider enrollment and hospital privileges for BayCare physicians and providers.
• Complete primary source verifications and assess providers’ qualifications to meet BayCare’s quality standards.
• Document verifications and data in the credentialing database to produce credentialing files meeting BayCare’s standards within required timeframes.
• Ensure providers remain compliant with licensing and board requirements and assist with renewals.
• Enroll and maintain managed care enrollment by coordinating with plans, the CBO and the Managed Care contracting department.

Skills

Customer service

Attention to detail

Education

HS Diploma or GED

Associate or Bachelor’s degree preferred

Tools

Credentialing database

Job description

At BayCare, we are proud to be one of the largest employers in the Tampa Bay area. Our network consists of 16 community-based hospitals, a long-term acute care facility, home health services, outpatient centers and thousands of physicians. With the support of more than 30,000 team members, we promote a forward-thinking philosophy that’s built on a foundation of trust, dignity, respect, responsibility and clinical excellence.

BayCare is currently in search of our newest Team Member who is passionate about providing outstanding customer service to our community. We are looking for an individual seeking a career opportunity with one of the largest employers within the Tampa Bay area.

Position Details

• Location: Remote (must reside in the State of Florida)
• Status: Full Time (non-exempt)
• Shift: 8:00 AM to 4:30 PM (may vary)
• Days: Monday through Friday

The Credentialing and Provider Enrollment Specialist is a full-time remote position. This team member must currently reside in Florida.

Responsibilities

• Responsible for initiating and maintaining credentialing, managed care provider enrollment and hospital privileges for BayCare physicians and providers in accordance with NCQA, CMS, AHCA, State and Federal guidelines and regulations, as well as Department Policies, to ensure compliance with credentialing standards.
• Completes primary source verifications and assesses the provider's qualifications to ensure the providers meet BayCare’s quality standards.
• Documents all verifications and data in the credentialing database to produce credentialing files that meet BayCare’s quality standards within the time frames required by BayCare.
• Ensure providers remain compliant with all licensing and board requirements and will assist providers with renewals.
• Enrolls and maintains managed care enrollment by providing updates to the health/payor plans and will resolve errors and issues by coordinating with the plans, the CBO and the Managed Care contracting department.

Why BayCare?

Our network consists of 16 community-based hospitals, a long-term acute care facility, home health services, outpatient centers and thousands of physicians. With the support of more than 30,000 team members, we promote a forward-thinking philosophy that is built on a foundation of trust, dignity, respect, responsibility, and clinical excellence. Our team members focus on tomorrow by achieving personal and professional success today. That is why you will thrive in our forward-thinking culture, where we combine the best technology with compassionate service. We blend high-tech with high touch in ways that are advancing superior health care throughout the communities we serve.

BayCare Offers a Competitive Total Reward Package Including

• Benefits (Health, Dental, Vision)
• Paid time off
• Tuition reimbursement
• 401k match and additional yearly contribution
• Yearly performance appraisals and team award bonus
• Community discounts and more
• AND the Chance to be part of an amazing team and a great place to work!

Certifications and Licensures

• Preferred – CPCS (Credentialing)

Education

• Required HS Diploma or Equivalent GED
• Preferred associate or bachelor’s degree preferred.

Experience

• Required
• 1 year Credentialing or 1-year Managed Care

Equal Opportunity Employer Veterans/Disabled