Credentialing Specialist

Borland--groover-Clinic; Jacksonville (FL); Presencial; USD 48.000 - 60.000; Jornada completa

Descripción de la vacante

Borland Groover is a leading gastroenterology provider in Florida with a 1947 heritage, committed to quality care and collaboration. The Credentialing Specialist supports credentialing, enrollment, and maintenance of provider records with insurance plans, hospitals, and other organizations, ensuring accurate licenses, certifications, and enrollment status.

The ideal candidate is organized, detail-oriented, and enjoys collaborating with providers, payers, and internal teams to streamline

Formación

• Healthcare credentialing, enrollment or medical staff services experience.
• Familiarity with credentialing processes and payer enrollment.
• Ability to manage multiple priorities with strong attention to detail.
• Proficiency in Microsoft Office and electronic databases.
• Knowledge of credentialing platforms such as CAQH or Symplr is helpful.

Responsabilidades

• Assist with provider credentialing, enrollment, and recredentialing activities.
• Prepare and submit credentialing and enrollment applications.
• Monitor application status and follow up on outstanding items.
• Maintain provider participation with health plans and hospitals.
• Communicate with providers, health plans, hospitals, and internal teams.
• Maintain provider information in credentialing systems and ensure records are current.
• Update provider licenses, certifications, and required documentation.
• Assist with tracking logs and enrollment reports.
• Track renewal requirements and monitor expiration dates.
• Support compliance with payer and regulatory requirements.

Conocimientos

Communication

Critical Thinking

Time Management

Collaboration

Educación

Associate's/Bachelor's degree or equivalent

Herramientas

CAQH

Symplr

NPI

CEBroker

Descripción del empleo

POSITION TITLE: CREDENTIALING SPECIALIST

Borland Groover is one of Florida's leading gastroenterology providers. Founded in 1947, our mission is to provide exceptional care and improve the lives of our patients. We value ourselves on delivering quality care (quality), doing the right thing (accountability), caring for our patients (compassion), and taking care of our employees (collaboration).

POSITION SUMMARY

The Credentialing Specialist supports the credentialing, enrollment, and maintenance of healthcare providers with insurance plans, hospitals, and other organizations. This role helps ensure provider information, licenses, certifications, and enrollment records remain accurate and up to date.

The ideal candidate is organized, detail-oriented, and enjoys working with providers, payers and internal teams to support the credentialing process.

ESSENTIAL JOB FUNCTIONS

• Assist with provider credentialing, enrollment, and recredentialing activities.
• Prepare and submit credentialing and enrollment applications.
• Monitor application status and follow up on outstanding items.
• Maintain provider participation with health plans and other organizations.
• Help resolve credentialing and enrollment issues as they arise.

Provider Records & Database Maintenance

• Maintain provider information in credentialing and enrollment systems.
• Update provider profiles, licenses, certifications, and other required documentation.
• Ensure records are accurate, complete, and current.
• Assist with maintaining tracking logs and enrollment reports.

Compliance & Renewals

• Track provider licenses, certifications, registrations, and other renewal requirements.
• Monitor expiration dates and help ensure documentation remains current.
• Support compliance with payer and regulatory requirements.
• Serve as a point of contact for credentialing-related questions.
• Communicate with providers, health plans, hospitals, and internal departments.
• Provide updates regarding provider enrollment and participation status.
• Support provider onboarding, location additions, and other organizational changes.

ADDITIONAL RESPONSIBILITIES

• Must follow the organization’s Code of Conduct.
• Performs other related duties as assigned.

SCHEDULE:

Monday-Friday 9am-3pm

COMPETENCIES

• Communication: Practices active listening and communicates clearly and concisely, both verbally and in writing. Keeps open lines of communication with providers, patients, staff, and leadership so that patient needs are addressed and team members stay informed. Delivers feedback, policy updates, and expectations in a clear, consistent, and professional manner, and chooses the right communication method for each audience.
• Critical Thinking and Problem Solving: Handles complex and escalated situations calmly and develops effective solutions. Identifies root causes of recurring issues and puts corrective actions in place. Anticipates patient and operational needs and manages patient expectations of care delivery.
• Time Management: Plans and prioritizes team workload, staffing, and resources to meet service levels and deadlines. Uses technology to work efficiently and adjusts priorities quickly as department needs change.
• Collaboration: Builds trust and strong working relationships across multidisciplinary teams.

GENERAL QUALIFICATIONS

We welcome candidates from a variety of healthcare administrative backgrounds. The qualifications below are preferred but not required.

• Previous experience in healthcare administration, credentialing, provider enrollment, medical staff services, or a related field.
• Familiarity with provider credentialing and enrollment processes.
• Experience working with healthcare providers, hospitals, health plans, or managed care organizations.
• Strong organizational and time-management skills.
• Attention to detail and ability to manage multiple priorities.
• Effective written and verbal communication skills.
• Proficiency in Microsoft Office applications and electronic databases.
• Ability to work independently and collaboratively within a team environment.
• Preferred experience with credentialing platforms such as CAQH, Symplr, NPI, CEBroker, or similar systems is helpful.
• Knowledge of Medicare, Medicaid, commercial insurance, or managed care processes is a plus.

EDUCATION AND EXPERIENCE

Preferred:

• Associate's degree, Bachelor's degree, or equivalent work experience in Healthcare Administration, Business Administration, Health Information Management, or a related field.
• Experience in provider credentialing, enrollment, medical staff services, healthcare operations, physician relations, or related administrative support roles.
• Experience supporting provider licenses, certifications, hospital privileges, or payer enrollment activities.

PHYSICAL REQUIREMENTS

Physical Demands

• Heavy lifting: marginal
• Pushing/Pulling: marginal
• Repetitive motion: marginal
• Reaching: marginal

Emotional Demands

• Intense customer interaction: essential

Mental/Sensory Demands

• Health Insurance
• Vision Insurance
• 401K Retirement Plan
• Life Insurance
• Short- and Long-term disability
• Profit Sharing
• Supplemental Insurance
• Education and Tuition Reimbursement funding
• Employee Assistance Program (EAP)
• Paid Time Off (PTO)
• Paid Holidays

IMPORTANT NOTE

The above statements are intended to describe the general nature and level of work being performed. They are not intended to be an exhausted list of duties, responsibilities, and skills. Borland Groover is an equal opportunity employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws. We thank all applicants for their interest. However, only those selected for an interview will be contacted.