Credentialing Specialist

3 days ago

Jacksonville, Florida, United States GlyCare Full time

We are seeking a full-time detail-oriented and highly organized individual to join our team as a Credentialing Specialist. The successful candidate will play a crucial role in managing all aspects of provider credentialing, re-credentialing, and privileging with health plans, hospitals, and facilities. Additionally, the candidate will be responsible for maintaining accurate and current provider data, including licenses, certifications, and insurance information.

Responsibilities:

  • Track and renew credentials and privileges before expiration
  • Serve as the primary contact for hospitals, payers, and facilities regarding credentialing status and issues
  • Maintain complete, compliant provider files (digital and physical) per retention policies
  • Oversee payer contract renewals and maintain knowledge of payer requirements
  • Conduct credentialing and privileging for practitioners and facilities as applicable
  • Research and summarize credentialing requirements for various entities as needed
  • Maintain and document activities in credentialing software
  • Create and manage CAQH, NPPES, and PECOS accounts
  • Stay current with credentialing regulations, payer policies, and process updates

Excel Proficiency:

  • Utilize Excel for data analysis, reporting, and other relevant tasks.

Qualifications:

  • Strong knowledge of credentialing processes (government, Medicare, regulatory, state, and hospital), including primary source verification and delineation of privileges
  • Excellent organization, attention to detail, and time management skills
  • Strong communication and interpersonal skills for interaction with providers, staff, and payers
  • Ability to plan, prioritize, and meet deadlines independently
  • Reliable and dependable

Education and Experience:

  • High school diploma or equivalent
  • Minimum 3 years of credentialing and contracting experience
  • Proficiency in MS Word, Excel, Outlook; basic math skills
  • Familiarity with medical terminology, practices, and credentialing standards

Job Type: Full-time

Pay: $ $23.08 per hour

Benefits:

  • 401(k)
  • Dental insurance
  • Health insurance
  • Life insurance
  • Paid time off
  • Vision insurance

Ability to Commute:

  • Jacksonville, FL Required)

Ability to Relocate:

  • Jacksonville, FL 32256: Relocate before starting work (Required)

Work Location: In person

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