Healthcare Credentialing Specialist

5 days ago

Miami, FL, United States Pinnacle Wound Management Full time
Job Description
Pinnacle Wound Management is a leading wound care provider dedicated to delivering high-quality patient care. We are seeking a detail-oriented Healthcare Credentialing Specialist to join our team. This role is critical in ensuring our healthcare professionals meet all necessary licensing, certification, and regulatory requirements.

As a Healthcare Credentialing Specialist, you will be responsible for managing the credentialing and re-credentialing process for all of our physicians and mid-level healthcare providers. You will maintain accurate records, verify professional credentials, and ensure compliance with industry regulations and accreditation standards.

If you are a meticulous and organized professional with a passion for healthcare compliance, we want to hear from you Apply now to join us in ensuring the highest standards of wound care excellence

Key Responsibilities:

  • Maintain accurate and up-to-date provider files, ensuring compliance with all credentialing requirements
  • Complete and track initial and re-credentialing applications for various health insurance portals, including CAQH, PECOS, NPPES, Navinet, Availity, PaySpan, CMS, and Managed Care Organizations
  • Assist new providers with applications for National Provider Identifier (NPI), Medicare, and Medicaid numbers.Monitor and update provider CAQH profiles in accordance with CMS and Managed Care Organization guidelines
  • Manage termination of payer enrollments for providers leaving the organization
  • Provide updated demographic information and supporting documents to external stakeholders, including commercial payers and billing entities
  • Collaborate with the Director of Operations to ensure timely credentialing and re-credentialing of all providers.
  • Track and ensure the renewal of state DEA licenses, board certifications, and malpractice insurance
  • Identify and resolve potential onboarding issues, offering solutions to streamline the credentialing process
  • Maintain records of all managed care contracts and ensure portal logins remain active.Ensure compliance with relevant accrediting and regulatory agencies
  • Monitor trends and recommend improvements to credentialing workflows
Requirements
High school diploma or equivalent; credentialing certificate preferred Minimum of 5 years experience in physician credentialing, revenue cycle management, or related field Knowledge of credentialing standards and healthcare regulations Proficiency in credentialing software and Microsoft Office Suite Strong attention to detail, organizational, and problem-solving skills Excellent written and verbal communication skills Ability to work independently and manage multiple tasks efficiently

Benefits
  • 401k
  • 401k matching
  • Competitive pay
  • Medical, dental, and vision insurance
  • Paid time off
  • Free parking
  • No nights, no weekends
  • Monday - Friday, 8 hour shift

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