Remote Credentialing & Provider Enrollment Specialist

BayCare Health System; Town of Florida (NY); On-site; USD 55,000 - 75,000; Full time

Benefits offered by this job

Health insurance

Paid time off

Tuition reimbursement

401k match

Job summary

BayCare seeks a Credentialing and Provider Enrollment Specialist to support remote credentialing for physicians and providers while residing in Florida. This full-time role ensures alignment with NCQA, CMS, AHCA and state/federal guidelines.

You will verify primary sources, document verifications, maintain credentialing files, and assist renewals, collaborating with plans, the CBO and the Managed Care contracting department.

Qualifications

• High school diploma or GED required.
• Preferred associate or bachelor's degree.
• 1 year credentialing or 1 year managed care experience.
• CPCS certification preferred.

Responsibilities

• Initiate and maintain credentialing, managed care provider enrollment and hospital privileges for BayCare physicians and providers.
• Complete primary source verifications and assess providers’ qualifications to meet BayCare’s quality standards.
• Document verifications and data in the credentialing database to produce credentialing files meeting BayCare’s standards within required timeframes.
• Ensure providers remain compliant with licensing and board requirements and assist with renewals.
• Enroll and maintain managed care enrollment by coordinating with plans, the CBO and the Managed Care contracting department.

Skills

Customer service

Attention to detail

Education

HS Diploma or GED

Associate or Bachelor’s degree preferred

Tools

Credentialing database

Job description

BayCare seeks a Credentialing and Provider Enrollment Specialist to support remote credentialing for physicians and providers while residing in Florida. This full-time role ensures alignment with NCQA, CMS, AHCA and state/federal guidelines.

You will verify primary sources, document verifications, maintain credentialing files, and assist renewals, collaborating with plans, the CBO and the Managed Care contracting department.