Credentialing Specialist

2 weeks ago

Fort Lauderdale, United States Envision Staffing Solutions Full time
Our client in the healthcare space is looking for a Credentialing Specialist to join their team.

What You'll Be Doing:
  • Conducts comprehensive background investigations, research, and evaluation of components in application files; completes credentialing and re-credentialing for providers; monitors applications and follows up as needed; processes applications with relevant agencies or third-party payers to ensure compliance.
  • Manages credentialing for faculty and professional staff with Medicare, Medicaid, HMOs, PPOs, and other third-party carriers to secure provider contracts.
  • Maintains accurate and up-to-date provider data in databases and online systems, including information on education, training, licensing, and experience, ensuring practice addresses remain current with health plans, agencies, and other entities.
  • Applies for providers’ hospital privileges and oversees hospital reappointments, as well as managing requests and payments for medical staff dues to ensure timely and accurate handling.
  • Assists in maintaining the Clinical Laboratory Improvement Amendments (CLIA) certification for clinical operations.
  • Tracks the expiration dates of provider licenses and certifications to ensure timely renewals.
  • Ensures contact and licensing information does not lapse, submitting updated licensing information to the appropriate entities.
  • Maintains secure credential files for providers and supports college review committees.
  • Stays informed about new policies and procedures from third-party payers and communicates relevant updates to appropriate staff.
  • Ensures compliance with accrediting and regulatory agencies, and maintains a working knowledge of statutes and laws related to credentialing.
  • Assists with managed care delegated credentialing audits, conducts internal file audits, and verifies health plan directories for accurate provider information.
  • Responds to inquiries from other healthcare organizations and interfaces with internal and external stakeholders on credentialing and privileging issues.
  • Participates in contracting functions, maintaining an understanding of contract terms.
  • Performs other duties as assigned by the supervisor.
Experience You Bring:
  • Thorough knowledge of the credentialing process.
  • Familiarity with accreditation and certification requirements related to credentialing.
  • Strong ability to work independently while efficiently managing multiple projects with precision, adapting to change, and meeting deadlines.
  • Skilled in researching and analyzing data.
  • Dedicated to delivering excellent customer service, fostering effective working relationships with providers, staff, and both internal and external contacts.
  • Exceptional attention to detail and a high level of accuracy.
  • Effective verbal and written communication skills.
  • Proficiency in MS Office applications (Word, Excel, and Outlook) and strong skills in online research.
  • Experience in credentialing and/or insurance contracting within a medical setting.
  • Experience using credentialing software.
  • Certified Provider Credentialing Specialist (CPCS) qualification.

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