Credentialing Specialist

2 weeks ago

Leesburg, Florida, United States CAN Community Health Full time


Position Overview:

The Credentialing Specialist plays a vital role in the Credentialing Department by managing administrative responsibilities associated with the onboarding and offboarding of healthcare practitioners, credentialing processes, and health plan enrollment.

This role is essential in facilitating any demographic updates for physicians and ancillary providers within the clinical practice.

The Credentialing Specialist will monitor provider certifications and licensure expiration dates, ensuring that all healthcare professionals uphold current credentials and adhere to regulatory standards.

This position frequently collaborates with providers, practice administrators, billing vendors, and both commercial and governmental health plans, as well as credentialing vendors.

Core Values:
Recognize and affirm the unique and intrinsic worth of every individual.
Treat all stakeholders with compassion and kindness.

Conduct business and personal affairs with absolute honesty, integrity, and fairness.

Trust colleagues as valuable members of our healthcare team, committing to mutual respect and dignity.


Key Responsibilities:
Uphold and promote the mission and values of CAN Community Health Inc, adhering to its policies and procedures.
Ensure confidentiality is maintained by the entire team regarding patient/client information in compliance with HIPAA and professional standards.

Main Duties:


Collaborate with the Credentialing & Health Plan Enrollment Team Lead and Specialists to guarantee that physicians and ancillary providers are appropriately licensed and credentialed.

Provide consistent and timely follow-up throughout the credentialing process for healthcare providers, encompassing initial credentialing, re-credentialing, and health plan enrollment.

Assist in maintaining an up-to-date provider database to confirm that all healthcare providers are licensed, insured, and credentialed in accordance with regulatory guidelines.

Support the accuracy and completeness of credentialing documentation, ensuring compliance with regulatory standards and health plan requirements.
Assist in the review process of health plan provider rosters and directory reviews/attestations.
Engage in provider profile audits across multiple systems.
Communicate with healthcare providers, health plans, and regulatory agencies to address credentialing issues and ensure timely processing.
Coordinate with internal departments to gather necessary information and documentation for credentialing purposes.
Compile and maintain accurate records of credentialing and enrollment activities, including tracking deadlines and expiration dates.
Participate in quality improvement initiatives aimed at enhancing the efficiency and effectiveness of credentialing and enrollment processes.
Assist clinical providers with CAQH applications on behalf of CAN employed providers.
Maintain copies of current state licenses, DEA certificates, malpractice coverage, and any other required credentialing documents for all providers.
Ensure compliance with healthcare regulations, standards, and payer requirements during the credentialing and enrollment process.
Stay informed about healthcare regulations, accreditation standards, and health plan policies related to credentialing.
Adhere to HIPAA regulations and maintain patient confidentiality.

Additional Responsibilities:
Effectively communicate and collaborate with other departments to implement best practices while ensuring compliance with healthcare regulations and guidelines.
Assist in the setup and maintenance of provider information in online credentialing databases and systems.
Support the maintenance of corporate provider contract files.
Demonstrate integrity and commitment to the mission and values of the organization.
Perform other duties as assigned by Revenue Cycle Leadership.


Requirements:


Education/Professional Background:

  • Bachelor's degree in healthcare, Business, Finance, or equivalent healthcare experience (3 years minimum).
  • A minimum of three to five years of credentialing coordination experience is required.

Knowledge, Skills, and Abilities:

  • Ability to work independently with minimal supervision.
  • Experience working with medical payers, including Medicare, Medicaid, Commercial, and third-party administrators.
  • Strong attention to detail and accuracy in data entry and record-keeping.
  • Excellent written and verbal communication skills, along with strong interpersonal abilities.
  • Proficient in Microsoft Office (Excel, Visio, Word, PowerPoint) and adept at utilizing Internet resources.
  • Demonstrated ability to work well with others, openness to direction, and a commitment to completing tasks.
  • Promotes teamwork, productivity, and the delivery of high-quality care.
  • Comfortable working in a diverse environment with shifting priorities.

Physical Requirements:
Frequent bending, stooping, and standing are required. The role necessitates visual and auditory acuity, as well as prolonged sitting and walking.


CAN is an equal opportunity employer committed to diversity and values the unique perspectives that individuals bring to the organization.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

Remote working/work from home options are available for this role.

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