Florida Heart Associates is recruiting for a full-time Credentialing Specialist to join our team. This is an excellent opportunity to join a stable, growing cardiology practice. The Credentialing Specialist is responsible for all aspects of the credentialing, re-credentialing and privileging processes for all medical providers who provide patient care at Florida Heart Associates. The Credentialing Specialist is responsible for ensuring providers are credentialed, appointed, and privileged with health plans, hospitals and patient care facilities. Maintain up-to-date data for each provider in credentialing databases; ensure timely renewal of licenses and certifications. The Credentialing Specialist also ensures compliance with CAQH standards.

Located in the attractive Southwest Florida Gulf Coast area, Florida Heart Associates is a fully accredited, modern medical center dedicated to meeting the cardiac needs of Southwest Florida. We perform diagnostic cardiac testing, in addition to peripheral vascular procedures. We also support an in-house cardiac PET imaging system, stress testing, ECHO, and management of arrhythmia equipment.

EXPERIENCE: Three years of relevant credentialing experience required.

CERTIFICATE/LICENSE: Certified Provider Credentialing Specialist (CPCS) preferred.

EDUCATION: High school diploma or equivalent. Associate degree preferred.

DUTIES:

• Performs initial credentialing and re-credentialing according to CAQH standards for all Physicians and Advance Practice Providers for government and commercial health plans.
• Manages the on-boarding process internally/externally to include obtaining hospital privileges within the appropriate timeframe.
• Create and maintain credentialing database or company chosen platform to keep data current and accurate.
• Compiles and maintains current and accurate data for all providers.
• Completes provider credentialing and re-credentialing applications; monitors applications and follows-up as needed.
• Performs enrollment functions, including but not limited to: CAQH and PECOS on-line application systems including enrollment for commercial, State and Federal payers.
• Performs relevant data entry into the credentialing database to ensure consistency and integrity of the data.
• Maintains copies of current state licenses, DEA certificates, malpractice coverage and any other required credentialing documents for all providers.
• Track state license, DEA and professional liability insurance expiration for all medical providers.
• Maintains corporate provider contract files.
• Maintains knowledge of current health plan and agency requirements for credentialing providers.
• Set up and maintain provider information in credentialing databases and systems.
• Tracks license and certification expirations for all providers to ensure timely renewals.
• Audits health plan directory to ensure providers have current and accurate provider information.
• Ensures practice addresses are current with health plans, agencies and other entities.
• Ensures work history is documented correctly.
• Actively participates in credentialing quality improvement program maintaining or exceeding timeliness, accuracy and production standards.
• Scan and file documents and appropriately prepare and index provider files.
• Maintains strict confidentiality of all data used in the credentialing process, including appropriate disposal of confidential documents.
• Ensures that all health care professional’s data and Protected Health Information (PHI) is maintained, transmitted, and stored in a confidential and secure manner.
• Works closely with billing staff to identify and resolve any denials or authorization issues related to provider credentialing.
• Provides credentialing and privileging verification.
• Performs other duties assigned in an efficient, effective and cost-conscious manner, complying with company policies and procedures.
• Perform other duties as assigned by supervising manager.

PERFORMANCE REQUIREMENTS:

• Demonstrated knowledge and thorough understanding of the credentialing process.
• Highly organized with ability to prioritize work and manage multiple priorities and competing deadlines.
• Excellent verbal and written communication skills including letters, memos and emails.
• Excellent attention to details.
• Excellent customer service skills; communicates clearly and effectively.
• Professional attitude, tone and demeanor.
• Ability to research and analyze data.
• Ability to work independently with minimal supervision.
• Ability to establish and maintain effective working relationships with providers, management, staff and contacts outside of the organization.
• Intermediate computer skills with proven knowledge of database creation and maintenance.
• Proficient use of Microsoft Office applications.
• Ability to maintain strictest confidentiality.

Florida Heart Associates is an Equal Opportunity Employer and is proud to be a drug and tobacco free organization.

Job Type: Full-time

Benefits:

• 401(k)
• 401(k) matching
• AD&D insurance
• Dental insurance
• Disability insurance
• Employee assistance program
• Health insurance
• Health savings account
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• Monday to Friday

Experience:

• credentialing: 3 years (Preferred)

Work Location: In person

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