Senior Facility Credentialing Lead — Compliance & Audits

Healthfirst; Florida; On-site; USD 52,000 - 68,000; Full time

Job summary

Healthfirst in Florida seeks a Credentialing Specialist to credential and re-credential providers, facilities and vendors, and to prepare hard-copy directories while reviewing network data for accuracy and regulatory compliance.

The role includes presenting at quarterly credentialing meetings, facilitating audits, and communicating effectively with internal teams and external partners to ensure adherence to state and federal regulations.

Qualifications

• HS diploma or GED is required.
• Facility credentialing experience is required.

Responsibilities

• Credentials providers, facilities, and vendors in accordance with regulations and Healthfirst policy.
• Prepares presentations for the quarterly credentialing and delegate vendor oversight committee meetings.
• Facilitates pre-delegation and delegation vendor audits to ensure adherence to contractual arrangements.
• Prepares hard-copy directories and works with third party vendors for posting online directories. Reviews relevant data to ensure accuracy.
• Effectively communicates to internal departments and external partners.
• Identifies and assesses opportunities to improve processes to better ensure regulatory compliance and adherence to state and federal regulations.
• Raises issues to management and assists in resolution.
• Additional duties as assigned.

Skills

Time management

Project management

Communication

Problem-solving

Creative thinking

Critical thinking

Microsoft Office

Education

HS diploma/GED

Bachelor’s degree

Tools

Adobe

Access

Excel

Word

PowerPoint

Office

Job description

Healthfirst in Florida seeks a Credentialing Specialist to credential and re-credential providers, facilities and vendors, and to prepare hard-copy directories while reviewing network data for accuracy and regulatory compliance.

The role includes presenting at quarterly credentialing meetings, facilitating audits, and communicating effectively with internal teams and external partners to ensure adherence to state and federal regulations.