Credentialing Specialist

Paradigm; Tampa (FL); On-site; USD 42,000 - 64,000; Full time

Job summary

Paradigm, located in Tampa, FL, is seeking a detail-oriented Credentialing Specialist to support credentialing and re-credentialing of healthcare providers. The role emphasizes accuracy, compliance, and collaboration with QAIR, Risk Management, and Provider Relations teams.

You will maintain practitioner files, verify licenses and certifications, and ensure data integrity within credentialing systems, while upholding confidentiality and security policies consistent with the organization.

Qualifications

• Bachelor's degree in healthcare or technical field preferred.
• Exceptional communication and telephone skills required.
• Experience working with physicians and/or senior executives preferred.
• Strong organizational and multitasking abilities; ability to work independently.
• Proficient computer skills; familiarity with Microsoft Office.
• Knowledge of medical terminology preferred.
• NAMSS CPCS or CMSC preferred.

Responsibilities

• Completes credentialing and re-credentialing application process for internal and affiliated practitioners.
• Processes requests, investigations, verifications, tracking and follow-up from sources.
• Identifies, investigates, reports, and follows up on adverse information from credentialing sources.
• Maintains knowledge of policies, standards, regulations, and laws in credentialing.
• Populates and maintains credentialing software and filing systems.
• Assists with reports and RFPs in collaboration with supervisor.

Skills

Exceptional communication

Telephone skills

Organizational skills

Multitasking

Self-directed work

Education

Bachelor's degree in healthcare or technical field

Tools

Microsoft Office

Job description

Join Paradigm and help support the credentialing and re-credentialing of healthcare providers who make a difference in the lives of patients with complex injuries and diagnoses. We're looking for a detail-oriented professional who thrives in a fast-paced environment and enjoys working collaboratively to ensure quality, compliance, and exceptional service. As a four-time Great Place to Work® and three-time Fortune Best Workplaces in Health Care™ recipient, Paradigm offers a culture where you can grow, contribute, and make an impact every day.

RESPONSIBILITIES:

• Completes credentialing and re-credentialing application process of all internal and affiliated community practitioners.
• Processes request, investigation, verification, tracking and follow up of primary responses from various sources.
• Identifies, investigates, reports, tracks, and follows-up on any potentially adverse information received from credentialing sources.
• Obtains and maintains appropriate knowledge of company policy and procedures, accreditation standards, state and federal regulations, guidelines, procedures and laws required in credentialing process.
• Populates, updates, and maintains credentialing software and filing systems.
• Assists with Requests for Proposals or any requested reports as necessary and in collaboration with supervisor or other Credentialing Services staff.
• Maintains practitioner files annually.
• Ensures medical licenses, DEA certificates and malpractice certificates are current at all times for affiliated community practitioners.
• Works with designated QAIR Peer Review and Member Services personnel prior to each Credentialing/Peer Review meeting and continuously coordinates Peer Review information into credentialing and re-credentialing files.
• Collects site visit information from Provider Relations on appropriate practitioner files in preparation for Credentialing/Peer Review Committee approval meetings.
• Works with Risk Management to identify and coordinate any risk management, substance abuse and/or malpractice issues. Reviews files for any "red flag" issues.
• Prepares practitioner profiles and completes permanent file for review and approval at each Credentialing/Peer Review Committee meeting.
• Participates in professional organizations and/or other organizations addressing credentialing, compliance and/or risk management activities.
• Maintains strict confidentiality of all records, data and occurrences as condition of initial and/or ontinued employment.
• Maintain reliable and predictable attendance during scheduled work hours.
• Utilizes AI tools to support day-to-day tasks, improve efficiency, and enhance output quality. Adopts new technologies as trained and applies them in alignment with established processes and guidelines.
• Demonstrates a customer-first mindset by developing a broad and deep (where appropriate) understanding of Paradigm organization, products, operations, and customers. Prioritizes collaboration to meet customer needs and expectations and takes personal accountability for service quality.
• Responsible for complying with Paradigm Information Security requirements and policies, for safeguarding Paradigm or Paradigm related passwords, and for notifying Paradigm of any Information Security incidents per policy SEC 10-12 Information Security Incident Management.

QUALIFICATIONS:

• Bachelor's degree in health care or technical field preferred, call center experience a plus.
• Exceptional communication and telephone skills required, as well as a great deal of patience and understanding.
• Experience working with physicians and/or senior executives preferred.
• Possess a high level of self-confidence and persistence; maintain an assertive approach in dealing with providers.
• Must possess excellent organizational skills and the ability to multi-task effectively.
• Demonstrate the ability to prioritize heavy workload and work independently with minimal supervision.
• Proficient computer and internet skills; familiarity with Microsoft Office software required.
• Knowledge of medical terminology preferred.
• Certified Provider Credentialing Specialist (CPCS) or Certified Medical Staff Coordinator (CMSC) by the National Association Medical Staff Services (NAMSS) preferred.
• Will develop in-depth knowledge of department and company internal workflows including, but not limited to individual state’s procedures and negotiating protocols.