Medical Credentialing Specialist

Healthcare Coding And Consulting Svcs•Fort Myers, FL

3d•Remote

About The Position

We are seeking a full-time Credentialing Coordinator/Specialist to manage the credentialing and re-credentialing process for 132 providers across 12 facilities. This role is critical in ensuring compliance with regulatory standards, payer requirements, and organizational policies. The Credentialing Coordinator/Specialist will maintain organized workflows, verify provider credentials, and collaborate with key stakeholders to uphold high-quality care standards across all facilities.

Requirements

High school diploma or equivalent required; Associate's or Bachelor's degree in healthcare administration or related field preferred.
Minimum of 2 years of credentialing experience in a healthcare setting.
Knowledge of NCQA, JCAHO, and CMS standards.
Familiarity with payer enrollment processes.
Proficient in Microsoft Office Suite and credentialing software (e.g., CAQH, MD-Staff).
Exceptional organizational skills and attention to detail.
Strong communication and problem-solving abilities.
Ability to work independently and meet tight deadlines.
Microsoft Office: 2 years (Required)
Credentialing: 2 years (Required)

Nice To Haves

Certification as a Certified Provider Credentialing Specialist (CPCS) or Certified Professional Medical Services Management (CPMSM).
Experience managing credentialing for multiple providers and facilities.

Responsibilities

Manage credentialing and re-credentialing for 132 providers across 12 facilities, ensuring timely submissions and updates.
Verify and process provider credentials, including licensure, certifications, education, and work history.
Maintain accurate and up-to-date records in credentialing databases and software.
Coordinate with providers, payers, and facility administrators to resolve discrepancies or delays.
Ensure compliance with all applicable federal, state, and organizational regulations.
Prepare and submit applications for payer enrollment, hospital privileges, and re-credentialing as needed.
Collaborate with cross-functional teams to support operational and regulatory goals.
Monitor expiring credentials and notify providers of renewal deadlines.
Generate reports to track credentialing progress and meet organizational objectives.