Credentialing Associate

Femwell Group Health; Miami (FL); Hybrid; USD 45,000 - 65,000; Full time

Job summary

Femwell Group Health is seeking a Credentialing Associate to support credentialing and re-credentialing cycles and payer enrollment for practitioners.

You will maintain provider profiles, verify licenses, and ensure timely credentialing while adhering to NCQA, CMS and HIPAA standards. The role involves file management, audits, and collaboration with the Credentialing Committee.

Qualifications

• Minimum Associate Degree required; Bachelor or Master preferred.
• 2 years’ strong computer skills with Excel, Word, and data entry software.
• Healthcare administration experience preferred.
• Knowledge of HIPAA Security preferred.
• Hybrid rotation schedule and/or onsite as needed.

Responsibilities

• Credentialing and re-credentialing of physicians and midlevel providers.
• Meet all credentialing timelines in accordance with industry standards.
• Create and update provider profiles in credentialing software.
• Process primary source verification of provider information.
• Review provider applications and request additional documentation as needed.
• Maintain credentialing files and monitor information collection.
• Assist in annual review process and audits; prepare files for committee.
• Manage priorities and workload under pressure.

Skills

Excellent organizational skills

Strong verbal and writtencommunication

Ability to manage multiple projects

Education

Associate degree

Bachelor's degree

Master's degree

Tools

Microsoft Excel

Microsoft Word

PPT

Data entry software

Google tools

Cloud

Internet

Job description

The Credentialing Associate contributes to the overall success of the department by completing credentialing and re-credentialing cycles and payer enrollment for new and existing Practitioners.

Essential Job Functions

• Responsible for credentialing and re-credentialing (delegated / none delegated) Physicians and Midlevel providers as they join the group.
• Meet all credentialing and re-credentialing timelines in accordance with industry and company standards.
• Create and update provider profiles in credentialing software including provider registration and generating applications.
• Processes primary source verification of provider’ information e.g. license, references, NPDB report, Medicare/Medicaid sanction report, AMA profile, claims history, affiliations, etc.
• Review Provider applications and contact providers for any additional documentation or clarification needed.
• Maintain basic knowledge of credentialing delegation; requirements, oversight and industry standards.
• Responsible for set up and maintenance of all credentialing files in an organized manner and closely monitor information collection.
• Use conscious of all information received and pursue additional information if necessary. Includes analyzing information per policy, NCQA, CMS and ACHA standards.
• Assist in annual review process on timely credentialing, pre-assessments, annual audits, file review and analysis.
• Identify issues that require additional investigation and evaluation.
• Prepare files in accordance with Policy and Guidelines for the Credentialing Committee.
• Ability to manage the pressures associated with setting priorities, handling a large workload, and managing workflow.
• Other duties and responsibilities as deemed necessary according to business needs.

*NOTE: The list of tasks is illustrative only and is not a comprehensive list of all functions and tasks performed by this position.

Other Essential Tasks/Responsibilities/Abilities

• Must be consistent with Femwell’s core values.
• Excellent verbal and written communication skills.
• Professional and tactful interpersonal skills with the ability to interact with a variety of personalities.
• Excellent organizational skills and attention to detail.
• Excellent time management skills with proven ability to meet deadlines and work under pressure.
• Ability to manage and prioritize multiple projects and tasks efficiently.
• Must demonstrate commitment to high professional ethical standards and a diverse workplace.
• Must have excellent listening skills.
• Must have the ability to maintain reasonably regular, punctual attendance consistent with the ADA, FMLA, and other federal, state, and local standards and organization attendance policies and procedures.
• Must maintain compliance with all personnel policies and procedures.
• Must be self-disciplined, organized, and able to effectively coordinate and collaborate with team members.
• Must have ability to remain focused for long periods of time.
• Extremely proficient with Microsoft Office Suite or related software; as well as Excel, PPT, Internet, Cloud, Forums, Google, and other business tools required for this position.

Education, Experience, Skills, and Requirements

• Minimum Associate Degree required. Bachelor Degree or Master preferred.
• Minimum of 2 years’ strong computer skills utilizing Microsoft Excel, Word, and data entry software, with experience in manipulating data required.
• Healthcare administration experienced preferred.
• Knowledge of HIPAA Security preferred.
• Hybrid rotation schedule and/or onsite as needed.