Credentialing Coordinator

Team Member Services; Tampa (FL); On-site; USD 54,000 - 72,000; Full time

Benefits offered by this job

Medical Insurance

Dental Insurance

Vision Insurance

Life Insurance

Disability Insurance

PTO from Day One

403(b) Retirement Plan

Parental Leave

Career Development

Well-being Resources

Job summary

AdventHealth in Tampa, FL is seeking an experienced Credentialing Specialist to manage medical staff data across hospital sites. You will populate, update, and verify credentialing information, coordinate processing for new applicants and re-applicants, and respond to inquiries within policy guidelines.

The role requires strong data entry, reports, and collaboration with leadership while maintaining confidentiality and compliance with NCQA CAQH and payer operations.

Qualifications

• 3+ years in medical staff services/credentialing.
• Strong communication and collaboration across multiple sites.
• Proficient in MS Office and data entry.
• Knowledge of CAQH, NCQA, and payer operations preferred.

Responsibilities

• Populate, update and verify credentialing data for applicants and re-applicants.
• Coordinate processing for new credentialing applications.
• Respond to inquiries and resolve issues within policy guidelines.
• Produce tracking and advisory reports for leadership and contracts.
• Maintain confidentiality and ensure data integrity across sites.

Skills

Medical staff services

Communication skills

Interpersonal skills

Professionalism

Client management

Payroll knowledge

MS Office

Document imaging

Healthcare knowledge

Spanish (preferred)

Education

Associate

High School Grad/Equiv

Tools

ImageNow

Job description

Our promise to you:

Joining AdventHealth is about being part of something bigger. It’s about belonging to a community that believes in the wholeness of each person, and serves to uplift others in body, mind and spirit. AdventHealth is a place where you can thrive professionally, and grow spiritually, by Extending the Healing Ministry of Christ. Where you will be valued for who you are and the unique experiences you bring to our purpose-minded team. All while understanding that together we are even better.

All the benefits and perks you need for you and your family:

• Benefits from Day One: Medical, Dental, Vision Insurance, Life Insurance, Disability Insurance
• Paid Time Off from Day One
• 403-B Retirement Plan
• 4 Weeks 100% Paid Parental Leave
• Career Development
• Whole Person Well-being Resources
• Mental Health Resources and Support
• Pet Benefits

Schedule: Full time

Shift: Day (United States of America)

Address: 3100 E FLETCHER AVE

City: TAMPA

State: Florida

Postal Code: 33613

Job Description:

Populates, updates, and verifies the correctness and completeness of database information on an ongoing basis. Coordinates and provides administrative support for processing, verifying, and maintaining credentialing information for new applicants and re-applicants to all hospital sites. Performs and tracks primary source and other required verifications for all applicants according to established policies and procedures. Responds to customer inquiries and resolves problems within established policies and procedures. Prepares and provides client advisory reports, including status reports, expired items reports, and completed file reports to meet contractual time frames. Uses critical thinking skills to flag incongruent issues or information during credentialing and data entry tasks. Manages the integrity of the credentialing database and appropriateness of hard copy information received and provided to contracted entities. Produces tracking reports to detect and resolve work in process issues. Provides departmental administrative support to leadership in carrying out activities and coordinates completion of related projects. Supports the health system mission, values, and philosophy, maintaining adherence to professional confidentiality standards. Ensures information is maintained confidentially as required by local, state, and federal law. Maintains ongoing communication and feedback with all stakeholders, customers, and staff. Performs other duties as assigned.

Knowledge, Skills, and Abilities:

• Demonstrated experience in effectively providing medical staff services and support. [Required]
• Ability to communicate (verbal/written) effectively at different levels of the organization. [Required]
• Demonstrated interpersonal skills and ability to support and work in collaboration with multiple sites as needed. [Required]
• Professional demeanor, business acumen, political astuteness, adaptability, and diplomacy combined with the ability to establish and maintain collaborative relationships across the organization. [Required]
• Demonstrated client management skills including customer service and physician relations. [Required]
• Team oriented with a high degree of initiative; a self-starter with demonstrated data entry, administrative skills, and proficiency in payroll, accounts payable, and accounts receivable. [Required]
• Highly detail-oriented and organized with analytical and critical thinking skills. The ability to produce and proof reports and type correspondence is essential. [Required]
• Results driven with the ability to effectively multi-task, manage conflicting priorities, and function in demanding, stressful, and fast-paced confidential environments. [Required]
• Computer skills and proficiency in MSOffice (Word, Excel, Access, PowerPoint, Outlook), document imaging (i.e., fax, scanner, Image Now), and knowledge of healthcare, hospital/provider operations, and managed care payer operations. [Required]
• General knowledge of healthcare, hospital and provider operations, managed care payer contracts and operations, NCQA requirements for delegated credentialing, CAQH, and MD Staff and/or other systems used to determine provider medical privileges. [Preferred]
• Prior experience in credentialing, privileging, practitioner database management, insurance (governmental and 3rd Party Payers), and additional language skills (i.e., Spanish) is preferred.

Education:

• Associate [Preferred]
• High School Grad or Equiv [Required]

Field of Study:

• in Healthcare related field

Work Experience:

• 3+ in medical staff services, CVO, managed care credentialing or healthcare related experience [Required]

Additional Information:

- N/A

Licenses and Certifications:

• Certified Provider Credentialing Specialist (CPCS) [Preferred]
• Certified Professional Medical Staff Management (CPMSM) [Preferred]

Physical Requirements:

Physical Requirements - https://tinyurl.com/2