Credentialing & Enrollment Expert

Univida Medical Centers; Miami (FL); On-site; USD 54,000 - 72,000; Full time

Job summary

UniVida Medical Centers is seeking a Credentialing Specialist to coordinate provider credentialing, recredentialing, enrollment, and privileging processes. You will verify credentials, maintain accurate records, and ensure compliance with CMS, NCQA, and payer requirements.

The role involves collaboration with providers, health plans, and regulatory agencies, plus audits and ongoing regulatory updates. Occasional travel to clinics may be required.

Qualifications

• Associate or bachelor’s degree in healthcare admin, business, or related field preferred.
• Minimum 2–3 years of provider credentialing experience in a healthcare setting.
• Thorough knowledge of CMS regulations, Medicare enrollment, and credentialing standards.
• Experience credentialing physicians, NPs, PAs, and ancillary providers.
• Proficiency with CAQH, PECOS, NPPES, and provider data management systems.
• Familiarity with NCQA, URAC, Joint Commission, and state regulatory requirements.

Responsibilities

• Coordinate and process initial credentialing, recredentialing, privileging, and provider enrollment applications.
• Verify credentials through primary source verification (licensure, education, training, board certs, employment, malpractice, references).
• Ensure compliance with organizational, federal, state, and payer standards.
• Prepare and submit Medicare, Medicaid, and commercial payer enrollment applications and revalidations.
• Maintain provider records and credentialing documentation.
• Monitor expiration dates for licenses, registrations, board certs, and malpractice insurance.
• Conduct sanctions screening and exclusion monitoring (OIG, SAM, state databases).
• Communicate with providers, plans, hospitals, and regulators about credentialing requirements.
• Assist providers with applications and resolve deficiencies.
• Ensure CMS, NCQA, Joint Commission, URAC, payer, and state requirements compliance.
• Maintain HIPAA confidentiality.
• Prepare reports and credentialing tracking logs for timely processing.
• Participate in audits, accreditation reviews, and compliance initiatives.
• Stay current on credentialing regulations and industry best practices.
• Collaborate with internal departments to support onboarding and network participation.
• Perform other related duties as assigned.

Skills

Credentialing

Primary Source Verification

CAQH

PECOS

HIPAA Compliance

Excel

Education

Associate degree in healthcare administration

Bachelor’s degree in healthcare administration

Tools

Modio Health

VerityStream

symplr

Job description

UniVida Medical Centers is seeking a Credentialing Specialist to coordinate provider credentialing, recredentialing, enrollment, and privileging processes. You will verify credentials, maintain accurate records, and ensure compliance with CMS, NCQA, and payer requirements.

The role involves collaboration with providers, health plans, and regulatory agencies, plus audits and ongoing regulatory updates. Occasional travel to clinics may be required.