Provider Credentialing Specialist

We are seeking a highly skilled and detail-oriented professional to join our team as a Provider Credentialing Specialist.

The ideal candidate will possess a strong background in provider enrollment and a comprehensive understanding of the credentialing process.

This role is crucial for ensuring timely and accurate submission of provider applications, facilitating smooth onboarding, and maintaining compliance with all relevant regulations.

• Key Responsibilities:
• Provider Enrollment & Application Management:
• Demonstrated expertise in the end-to-end provider enrollment process.
• Proficiency in accurately completing a high volume of provider applications across various specialties and payer types.
• Ensuring timely and efficient submission of all completed applications to relevant entities.
• Tracking application statuses and proactively following up on outstanding items to expedite approval.
• Welcome Kit Generation & Contract Loading:
• Responsible for the creation and dissemination of comprehensive Welcome Kits for new providers, ensuring all necessary documentation and information is included.
• Accurate and efficient loading of provider contracts into the designated system, ensuring all terms and conditions are correctly captured.
• Application Portal Expertise:
• Extensive experience in creating and managing accounts within key healthcare application portals, including:
• CAQH (Council for Affordable Quality Healthcare): Establishing and maintaining provider profiles for efficient data sharing.
• Medicaid: Navigating state-specific Medicaid enrollment processes.
• Medicare (PECOS portal): Submitting and managing Medicare enrollment applications through the Provider Enrollment, Chain and Ownership System.
• NPI (National Provider Identifier): Assisting providers in obtaining and managing their NPI numbers.
• Regional Credentialing Advantage:
• Experience working with providers specifically in Florida will be considered a significant advantage, demonstrating familiarity with state-specific regulations and payer requirements.
• Communication & Responsiveness:
• Maintain a high level of professionalism and responsiveness in all email communications, promptly addressing queries and providing clear, concise information to internal and external stakeholders.
• Compliance & Confidentiality:
• Strictly adhere to all HIPAA regulations and maintain the utmost confidentiality of sensitive patient and provider information.
• Ensure all credentialing activities are in full compliance with federal, state, and organizational guidelines.

• Education:
• Bachelor's Degree (Preferred) in a relevant major such as Healthcare Administration, Health Information Management (HIM), Business Administration, or Public Health.
• An associate's degree combined with relevant work experience (e.g., 2-3 years in provider enrollment or credentialing) may suffice for entry-level roles.
• Experience:
• Expertise in provider enrollment and credentialing processes, ensuring ethical and accurate completion and submission of applications across various specialties and payers (e.g., Medicaid, Medicare).
• Proficiency in managing accounts in CAQH, Medicaid, Medicare (PECOS), and NPI portals with a commitment to ethical standards in data handling.
• Florida experience (preferred): Familiarity with state-specific regulations and payer requirements, maintaining integrity in compliance.
• Technical Skills:
• High proficiency in Google Sheets (formulas, pivot tables, charts) and Google Docs, supporting a high-performance culture through efficient workflows.
• Excellent typing skills (speed and accuracy) for precise data entry, contributing to operational excellence.
• Strong knowledge of operating systems, software, and browsers to uphold professional performance standards.
• Compliance & Ethics:
• Strict adherence to HIPAA and federal/state credentialing guidelines, ensuring ethical conduct in all processes.
• Maintain confidentiality of sensitive information with unwavering integrity.