Credentialing Specialist

Community Health of South Florida, Inc.; Miami (FL); On-site; USD 32,111 - 41,465; Full time

Job summary

Community Health of South Florida, Inc. seeks a full-time Credentialing Specialist in Miami, FL, responsible for credentialing and recredentialing all providers and facilities. Candidates should have five years of healthcare experience and relevant certifications, ensuring compliance with regulatory standards.

This role requires proficiency with Microsoft Office, knowledge of healthcare practices, and understanding of Managed Care Organizations. Competitive salary range from $23.31 to $30.10 hourly.

Qualifications

• Five years of experience in a healthcare-related position.
• Must maintain current CPR certification from the American Heart Association.
• Certified Professional Coder (CPC/CPCA) required.

Responsibilities

• Lead and coordinate credentialing and recredentialing processes.
• Process credentialing applications for healthcare providers.
• Ensure compliance with all accreditation and regulatory standards.
• Track license and certification expirations for timely renewals.

Skills

Knowledge of PC usage

Windows and Microsoft Office Applications

Database software

Spreadsheet software

Word processing software

Knowledge of healthcare practices

Understanding of credentialing process

Clear understanding of Managed Care Organizations

Education

Associate's degree or equivalent

Job description

If you are unable to complete this application due to a disability, contact this employer to ask for an accommodation or an alternative application process.

Credentialing Specialist

Active - Salary full-time Miami, FL, US

2 days ago Requisition ID: 1898

Salary Range: $23.31 To $30.10 Hourly

Position Purpose

The Credentialing Specialist is responsible for credentialing and recredentialing all billable providers, specialties, and facilities. Obtain access to the different MCO, Medicaid, and Medicare portals for credentialing. The purpose is to credential the providers in a timely manner to enable CHI to bill for services provided. Will provide support to the Director of Managed Care.

Position Requirements / Qualifications

Education/Experience: Five years of experience in a healthcare-related position and/or Associate's degree or equivalent from a two-year college or technical school or equivalent combined experience. Experience working in a health care organization preferred Coding experience preferred

Licensure / Certification:

Must maintain current CPR certification from the American Heart Association. Certified Professional Coder (CPC/CPCA) required.

Skills / Ability:

Knowledge of PC usage, Windows and Microsoft Office Applications, Database software, spreadsheet software, word processing software.

Knowledge of healthcare and/or community health center industry and practices.

Knowledge of Managed Care Organizations and their different lines of business; Commercial, CMS (Medicaid and Medicare)

Clear understanding of credentialing process

Position Responsibilities

• Primarily responsible for leading, coordinating, monitoring, and maintaining the credentialing and recredentialing process
• Primarily responsible for processing credentialing, re-credentialing and enrollment applications of healthcare providers and sites, enforcing regulatory compliance and adhering to quality assurance standards
• Performs accurate and timely credentialing processes for all initial applications and reappointments
• Maintains current knowledge and ensures compliance with all accreditation, regulatory, health plan standards, and CMS
• Ensures all primary source verification is completed within the time-frame as allowed by regulatory and accreditation entities
• Proactively works with center designees to acquire necessary materials and information
• Processes all appropriate queries for licensure or any appropriate regulatory credentialing requirements, and maintains documentation in the database
• Collects and verifies sensitive provider data through confidential sources
• Performs analysis and appropriate follow-up of all applications
• Identifies issues that require additional investigation and evaluation, validates discrepancies and ensures appropriate follow up
• Ensures proper escalation of any issues impacting the completion of the application(s) or concerns brought forth by center/stakeholder
• Completes accurate and timely data entry into the database to ensure consistency and integrity of the data
• Tracks license and certification expirations for all providers to ensure timely renewals
• Prepares files for presentation to leadership and the credentialing committee
• Ensures timely and effective communication with centers and stakeholders on the progress of all applications, addresses any inquiries set forth
• Provides monthly reports of the credentialing and enrollment status to centers on the status of all assigned providers
• Assists with internal auditing functions and performs peer evaluations as assigned
• Audits health plan directories for current and accurate provider information
• Supports credentialing committee meetings as needed
• Subject Matter Expert on Delegated and 3rd Party Payers