Provider Credentialing & Enrollment Lead (Hybrid)

Floridaortho; Tampa (FL); Hybrid; USD 52,000 - 68,000; Full time

Job summary

Floridaortho in Tampa, FL is seeking a Provider Enrollment & Credentialing Coordinator to manage credentialing, enrollment, recredentialing and privileging for employed and contracted practitioners. You will maintain provider data, submit documentation, and support compliance with NCQA, URAC, and CMS.

The role requires coordinating with providers, payers, and internal teams, handling NCQA standards, and maintaining accurate records across credentialing systems.

Qualifications

• Minimum 2 years of provider credentialing or enrollment experience.
• Working knowledge of NCQA, URAC, CMS credentialing standards.
• Proficiency with Excel and Office Suite; comfortable with electronic databases.
• Ability to handle sensitive data with confidentiality and accuracy.
• Excellent verbal and written communication skills.

Responsibilities

• Coordinate initial credentialing and recredentialing for physicians, physician assistants, and advanced practice providers across Medicare, Medicaid, commercial insurers, and delegated payers.
• Obtain and maintain NPI provider numbers utilizing PECOS, Medicaid, Availity and NPPES websites.
• Prepare credentialing files for FOI Credentialing Committee and primary source verifications.
• Track and maintain provider insurance participation status and effective dates in Athena.
• Maintain timely and accurate data entry in credentialing databases and payer portals; update provider rosters and profiles as needed.
• Process facility privilege applications and reappointments of privileges.
• Monitor and manage expirable documents (licenses, DEA, board certifications, malpractice insurance).
• Submit and update provider information in CAQH ProView as required by plans.
• Ensure compliance with NCQA, URAC, CMS, and payer requirements for credentialing and enrollment.
• Assist with issue resolution and communication with payers regarding enrollment status and delays.
• Upload and track CME documentation in relevant databases (e.g., CE Broker).
• Participate in internal audits and process improvements.

Skills

Healthcare administration

Provider credentialing

Attention to detail

Organization

Communication skills

Education

Bachelor's degree in healthcare administration

CPCS certification (preferred)

Tools

Microsoft Excel

Office Suite

Athenahealth

VerityStream

Job description

Floridaortho in Tampa, FL is seeking a Provider Enrollment & Credentialing Coordinator to manage credentialing, enrollment, recredentialing and privileging for employed and contracted practitioners. You will maintain provider data, submit documentation, and support compliance with NCQA, URAC, and CMS.

The role requires coordinating with providers, payers, and internal teams, handling NCQA standards, and maintaining accurate records across credentialing systems.