Healthcare Credentialing Specialist

Pinnacle Wound Management•South Miami, FL

28d

About The Position

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!

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

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