Supervisor - Credentialing and Contracting Specialist

1 week ago


Fort Lauderdale, Florida, United States Nova Southeastern University Full time
Job Summary

Nova Southeastern University is seeking a highly skilled Credentialing and Contracting Specialist to join our team. As a key member of our staff, you will be responsible for planning, directing, and coordinating work activities related to credentialing and contracting.

Key Responsibilities
  • Plan, direct, and coordinate work activities related to credentialing and contracting, including hiring, coaching, evaluating, and terminating staff members.
  • Conduct thorough background investigations and research of application files, complete provider credentialing and re-credentialing applications, and monitor applications to ensure compliance.
  • Perform credentialing of faculty and professional staff with Medicare, Medicaid, HMO, PPOs, and other third-party carriers to ensure providers are contracted.
  • Maintain up-to-date data for each provider in databases and online systems, ensuring practice addresses are current with health plans, agencies, and other entities.
  • Apply for provider hospital privileges, responsible for hospital reappointments, and responsible for medical staff due payments requests and payment processing to ensure timely and accurate treatment.
  • Drive and implement seamless protocols for gathering credentialing data from healthcare providers.
  • Assist in the development and implementation of process improvement initiatives.
  • Participate in the development of policies and procedures.
  • Track license and certification expirations for providers to ensure timely renewal, ensuring contracts and licenses do not expire, and submitting new licensing information to appropriate entities.
  • Maintain provider credential files securely and provide support for college review committees.
  • Keep up-to-date on new policies and procedures from third-party payers and communicate with staff.
  • Ensure interpretation and compliance with the appropriate accrediting and regulatory agencies.
  • Assist with managed care delegated credentialing audits, conduct internal file audits, and audit health plan directories.
  • Respond to inquiries from other healthcare organizations and interface with internal and external customers on day-to-day credentialing and privilege issues.
  • Participate in contracting functions and be responsible for understanding contract terms.
  • Complete other projects as assigned.
Requirements
  • Associate degree or sixty (60) completed college credit hours.
  • Minimum five (5) years of credentialing and/or contracting experience.
  • Prior supervisory experience.
  • Experience with credentialing and/or insurance contracting in a medical setting.
  • Experience with credentialing software.
  • Certified Provider Credentialing Specialist (CPCS).
Working Conditions

This is a safety-sensitive position. Background screening is required. Nova Southeastern University is an equal opportunity employer and does not discriminate on the basis of disability in the application and employment process.


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