Credentialing Specialist

JOB OVERVIEW: Responsible for all aspects of the credentialing, re-credentialing and privileging processes for all medical providers who provide patient care at Northeast Florida Health Services (NEFHS). 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 and online systems; ensure timely renewal of licenses and certifications.

ESSENTIAL FUNCTIONS INCLUDE BUT ARE NOT LIMITED TO:

• Assist with the credentialing and re-credentialing process for all healthcare providers, including physicians, nurse practitioners, physician assistants, and allied health professionals.

• Assist with reviewing and verifying provider credentials, including education, training, licensure, board certifications, professional liability insurance, and relevant work history to submit to payors as needed.

• Collaborate with the supervisor to facilitate credentialing and resolve any issues or discrepancies.

• Participate in credentialing meetings, presenting findings and recommendations as needed.

• Monitor expirations of provider credentials with payors and proactively initiate the re-credentialing process in a timely manner.

• Stay informed about changes in credentialing standards, regulations, and best practices, and ensure that the organization remains in compliance.

• Provide support and guidance to providers and staff regarding credentialing-related inquiries and concerns.

• Maintain confidentiality and professionalism in handling sensitive provider information.

ADDITIONAL RESPONSIBILITIES:

• Maintains confidentiality of provider information.

• Provides credentialing and privileging verifications.

• Performs other administrative duties as assigned.

QUALIFICATIONS:

Education:

• High school diploma or equivalent.

• Associate degree preferred.

Certification/Licensure: Certified Provider Credentialing Specialist (CPCS) preferred.

Experience: Two years of relevant medical administrative/credentialing experience.

Skills:

• Knowledge and understanding of the credentialing process.

• Ability to organize and prioritize work and manage multiple priorities.

• Excellent verbal and written communication skills including but not limited to, letters, memos, and emails.

• Excellent attention to detail.

• 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 the organization.

• Proficient use of Microsoft Office applications (Word, Excel, Access) and internet resources.

Physical Requirements:

• Requires occasional lifting and carrying of items weighing up to 20 pounds unassisted. Requires frequent bending, reaching, and repetitive hand movements, standing, walking, squatting, and sitting, with some lifting, pushing, and pulling exerted regularly throughout a regular work shift.

The above is intended to describe the general content and requirements for the performance for this position. It is not to be construed as an exhaustive statement of duties, responsibilities or requirements.