Provider Credentialing & Enrollment Specialist

Unividamedicalcenters; Miami (FL); On-site; USD 60,000 - 75,000; Full time

Job summary

Unividamedicalcenters is seeking a Credentialing Specialist to manage credentialing, recredentialing, enrollment, and privileging for providers. You will verify credentials via primary sources and coordinate with plans, regulators, and internal teams to ensure timely, compliant processing.

Responsibilities include overseeing Medicare/Medicaid submissions, maintaining records, and monitoring credential renewals.

Qualifications

• 2–3 years of provider credentialing experience in a healthcare organization, medical group, hospital, or Medicare‑managed care environment.
• Thorough knowledge of CMS regulations, Medicare enrollment requirements, and provider credentialing standards.
• Experience credentialing and recredentialing physicians, nurse practitioners, physician assistants, and ancillary healthcare providers.
• Proficiency with primary source verification and provider data management systems.
• Familiarity with NCQA, URAC, Joint Commission, and state regulatory requirements related to credentialing and compliance.
• Knowledge of Florida healthcare licensing requirements and state‑specific credentialing regulations.

Responsibilities

• Coordinate and process initial credentialing, recredentialing, privileging, and provider enrollment applications.
• Verify provider credentials through primary source verification, including licensure, education, training, board certification, employment history, malpractice coverage, and references.
• Ensure providers meet credentialing requirements and maintain compliance with organizational, federal, state, and payer standards.
• Prepare, submit, track, and maintain Medicare, Medicaid, and commercial payer enrollment applications and revalidations.
• Maintain provider records and databases, ensuring accuracy and completeness of credentialing documentation.
• Monitor expiration dates for licenses, registrations, board certifications, malpractice insurance, and other credentials for timely renewals.
• Conduct sanctions screening and exclusion monitoring through OIG, SAM, and state databases.
• Communicate with providers, health plans, hospitals, and regulatory agencies regarding credentialing and enrollment requirements.

Skills

Organizational skills

Communication skills

Problem-solving

HIPAA compliance

Microsoft Office Suite

Education

Associate or Bachelor’s degree in healthcare administration, business administration, or related field

Tools

CAQH

PECOS

NPPES

Modio Health

VerityStream

symplr

Job description

Unividamedicalcenters is seeking a Credentialing Specialist to manage credentialing, recredentialing, enrollment, and privileging for providers. You will verify credentials via primary sources and coordinate with plans, regulators, and internal teams to ensure timely, compliant processing.

Responsibilities include overseeing Medicare/Medicaid submissions, maintaining records, and monitoring credential renewals.