Provider Enrollment & Credentialing Coordinator

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

Job Category: Managed Care

Requisition Number: PROVI002348

• Posted : January 21, 2026
• Full-Time
• Hybrid

Locations

Showing 1 location

Description

Job Summary:

The Provider Enrollment & Credentialing Coordinator is responsible for all aspects of provider enrollment, credentialing, recredentialing, and privileging processes for employed and contracted practitioners. This includes maintaining accurate provider data in credentialing databases, ensuring timely submission and renewal of required documentation and supporting compliance standards. The Coordinator will work closely with providers, payers, and internal departments to ensure practitioners are appropriately credentialed and enrolled to support timely patient access and reimbursement.

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 the PECOS, Medicaid, Availity and NPPES websites.
• Prepare Credentialing files for FOI Credentialing Committee. This would include completing all required 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), alerting providers and escalating unresolved expirations to the Manager.
• Submit and update provider information in the CAQH ProView system as required by participating health plans.
• Ensure compliance with NCQA, URAC, CMS, and payer requirements for provider credentialing and enrollment.
• Assist with issue resolution and communication with payers regarding credentialing/enrollment status and delays.
• Upload and track CME documentation in relevant databases (e.g., CE Broker).
• Communicate credentialing or enrollment issues and application delays to the Manager in a timely manner.
• Participate in internal audits, special projects, and process improvements as directed.
• Perform other duties as assigned by department leadership.

Education And Experience:

• Healthcare administration, business, or a related field preferred.
• Minimum 2 years of experience in provider credentialing or enrollment, preferably in a healthcare, medical group, or managed care environment.
• Working knowledge of:
• Credentialing standards (NCQA, URAC, CMS)
• Credentialing software and payer enrollment systems
• Proficiency in Microsoft Excel and Office Suite; comfort with electronic databases and file management systems.
• Strong attention to detail, organization, and ability to manage multiple tasks and deadlines.
• Effective verbal and written communication skills, especially in provider-facing interactions.
• Ability to handle sensitive data with a high level of confidentiality and accuracy.

Prefferred Qualifications & Skills

• Prior experience with delegated credentialing or payer audit support
• Experience using Athenahealth and VerityStream platforms
• Basic understanding of medical terminology and healthcare regulations
• CPCS (Certified Provider Credentialing Specialist) certification preferred but not required

Orthopaedic Solutions Management is a Drug Free Workplace

We are committed to maintaining a safe, healthy, and productive work environment. As part of this commitment, we operate as a drug-free workplace. All candidates will be required to undergo pre-employment drug screening and/or be subject to random drug testing in accordance with applicable laws and company policy.

Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws.For further information, please review the Know Your Rights notice from the Department of Labor.