Network Data Specialist Credentialing Team

FLORIDA DOCTORS GROUP CORP; Coral Gables (FL); On-site; USD 45,000 - 65,000; Full time

Benefits offered by this job

Opportunity for advancement

Paid time off

Training & development

Vision insurance

Job summary

Florida Doctors Group is seeking a Credentialing Specialist to verify provider qualifications, licenses, and certifications to ensure compliance with quality care standards.

The role focuses on primary source verification, data maintenance, and coordination with health plans and internal teams to resolve credentialing issues.

Qualifications

• Prior healthcare credentialing experience preferred.
• Proficient with Microsoft Office applications.

Responsibilities

• Collaborate with internal teams to resolve credentialing issues.
• Maintain current and accurate provider data.
• Complete facility and provider credentialing applications.
• Keep copies of licenses, DEA, malpractice coverage, and other documents.
• Monitor health plan contracting and credentialing requirements.
• Update online credentialing databases and systems.
• Track license and certification expirations.
• Ensure facility addresses are current with health plans.
• Process contracting applications with insurance companies.
• Audit health plan directories for accuracy.
• Perform other duties as assigned.

Skills

Credentialing knowledge

Organization

Communication

Data analysis

Independent work

Interpersonal skills

Attention to detail

Tools

Microsoft Office

Job description

Benefits:

Opportunity for advancement

Paid time off

Training & development

Vision insurance

Are you a detail-oriented professional looking to join a dynamic healthcare organization? Look no further! Florida Doctors Group is thrilled to announce that we are actively seeking a talented Credentialing Specialist to join our team.

The Credentialing Specialist performs primary source verification by ensuring participating practitioners and/or providers possess the appropriate practice experience, licenses, certifications, privileges, professional liability coverage, education, and professional and other qualifications to provide a level of quality care consistent with professionally recognized standards. The specialist ensures all credentialing data and functions are maintained & documented properly within the credentialing database and with the health plans, including, but not limited to, primary verification of medical license, DEA, Board certification, malpractice liability claims history, disciplinary actions, etc.

Role and Responsibilities:

Tasks:

• Collaborate with internal teams to resolve any credentialing-related issues

• Compiles and maintains current and accurate data for all providers

• Completes facility and provider credentialing applications

• Maintains copies of current state licenses, DEA certificates, malpractice coverage and any other required documents for facility and providers

• Maintains knowledge of current health plan and agency requirements for contracting and credentialing providers

• Maintains and sets up facility and provider information on online credentialing databases and system.

• Track’s license and certification expirations for facility and providers.

• Ensures facility addresses are current with health plans and other entities.

• Processes application and follow-up for contracting with insurance companies.

• Audit’s health plan directories for current and accurate facility and provider information.

• Other duties as assigned by the contracting team.

Skills/Abilities:

• Knowledge and understanding of the Credentialing process

• Ability to organize and prioritize work and manage multiple priorities

• Verbal and written communication skills including letters and emails

• Ability to research and analyze data

• Ability to work independently with minimal supervision

• Outstanding communication and interpersonal abilities

• Excellent attention to detail and organizational skills

-Prior experience in Healthcare credentialing or in the Healthcare industry

• Ability to work effectively with insurance companies, providers, management and staff Proficient with Microsoft Office Applications.