Supervisor - Credentialing and Contracting Specialist
1 week ago
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.
- 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).
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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