Credentialing Specialist

5 days ago

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

Nova Southeastern University is seeking a highly skilled Credentialing Specialist to join our team. As a key member of our healthcare team, you will be responsible for planning, directing, and coordinating work activities of subordinates and staff, including hiring, coaching, evaluating, and terminating, all in accordance with university policies and procedures.

Key Responsibilities
  • Conduct thorough background investigations and research of application files, complete provider credentialing and re-credentialing applications, monitor applications, and follow up to ensure compliance.
  • Perform credentialing of faculty and professional staff with Medicare, Medicaid, HMO, PPOs, and other 3rd party carriers to ensure providers are contracted.
  • Maintain up-to-date data for each provider in databases and online systems as it relates to education, training, licensing, and experience to ensure practice addresses are current with health plans, agencies, and other entities.
  • Apply for Provider's Hospital Privileges, responsible for hospital reappointments, and also 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, ensure contracts and licenses do not expire, and submit 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 Environment

This is a safety-sensitive position. Background screening is required. Nova Southeastern University is an equal opportunity employer and welcomes applications from diverse candidates.

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