Credentialing Specialist/Provider Enrollment

$39,520 - $43,680/Yr

BC Talent Solutions, LLC - Fort Lauderdale, FL

Full-time - Entry Level

Fort Lauderdale, FL

About the position

The Credentialing Specialist is responsible for ensuring that healthcare providers meet the necessary qualifications and standards required for practice within the organization. This role plays a crucial part in maintaining compliance with regulatory requirements and supporting the overall efficiency of medical office operations.

Responsibilities

• Review and verify the credentials of healthcare providers, including education, training, and licensure.
• Log incoming payer credentialing requests and payer contract requests in the corresponding computer system.
• Serve as the primary contact for all internal and external payer credentialing inquiries.
• Manage new and existing payer credentialing processes to ensure deadlines are met.
• Gather and maintain all credentialing documentation and obtain missing or incomplete information.
• Update existing payer credentialing documentation and applications.
• Maintain accurate records of credentialing processes and ensure timely updates to provider files.
• Collaborate with managed care organizations to facilitate the credentialing process.
• Utilize medical terminology to assess qualifications and communicate effectively with healthcare professionals.
• Stay informed about industry standards and regulatory changes affecting credentialing practices.
• Assist in the development and implementation of credentialing policies and procedures.
• Respond to inquiries related to provider credentials from internal teams and external stakeholders.

Requirements

• Minimum of 2 years of experience in payer contracting/credentialing, including application submission and contract negotiation.
• Knowledge of state Medicaid, Medicare, and commercial payer plans.
• Experience working for or with DME companies, including knowledge of the DME credentialing process.
• Strong organizational and administrative skills, with the ability to manage multiple projects simultaneously and meet deadlines.
• Exceptional attention to detail and accuracy in all work, with a commitment to producing high-quality results.
• Excellent communication skills, including the ability to write clear and concise correspondence and engage with a variety of stakeholders.
• Willingness to learn new skills and adapt to a fast-paced, rapidly changing environment.

Nice-to-haves

• Valid Certified Provider Credentialing Specialist certification.
• Experience in Microsoft Word.

Benefits

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