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Credentialing and Provider Enrollment Specialist

2 months ago

Tampa, Florida, United States BayCare Health System Full time

BayCare Health System is seeking a highly skilled Credentialing and Provider Enrollment Specialist to join our team. As a key member of our organization, you will be responsible for ensuring the credentialing and provider enrollment processes are compliant with regulatory requirements and industry standards.

Key Responsibilities:

  • Initiate and maintain credentialing and provider enrollment processes for BayCare physicians and providers in accordance with NCQA, CMS, AHCA, State and Federal guidelines and regulations.
  • Complete primary source verifications and assess the provider's qualifications to ensure they meet BayCare's quality standards.
  • Document all verifications and data in the credentialing database to produce credentialing files that meet BayCare's quality standards within the required time frames.
  • Ensure providers remain compliant with all licensing and board requirements and assist providers with renewals.
  • Enroll and maintain managed care enrollment by providing updates to health/payor plans and resolve errors and issues by coordinating with the plans, the CBO, and the Managed Care contracting department.

Why BayCare Health System?

Our organization is committed to providing high-quality patient care and services. We are a leading healthcare system in the Tampa Bay area, with a network of 16 community-based hospitals, a long-term acute care facility, home health services, outpatient centers, and thousands of physicians. Our team members are dedicated to delivering exceptional patient care and services, and we are seeking a skilled Credentialing and Provider Enrollment Specialist to join our team.

What We Offer:

  • A competitive total reward package, including benefits, paid time off, tuition reimbursement, 401k match, and more.
  • The opportunity to work with a talented team of healthcare professionals who are passionate about delivering exceptional patient care and services.
  • A chance to grow and develop your career in a dynamic and supportive work environment.

Requirements:

  • High school diploma or equivalent GED required.
  • Preferred associate or bachelor's degree.
  • 1 year of experience in credentialing or managed care.
  • Preferred CPCS (Credentialing) certification.