Green Key Resources is representing a Primary Care Medical Group in Miami, FL who is seeking an experienced Credentialing specialist to join their team!

This is a full time, Monday – Friday opportunity. Possibility for Hybrid/Remote for the right candidate. Initial training in office in Miami 33183.

The Provider Credentialing and Enrollment Specialist is responsible for coordinating, monitoring, and maintaining the credentialing and recredentialing process for providers (i.e., MDs, Dos, physician assistant, APRN’s etc.) within the organization. This position ensures that all the clinicians meet the necessary regulatory and policy requirements to practice within their specialty.

Role Competencies:

· Provides accurate, timely and documented verification of the information provided by new applicants as well as current clinicians.

· Completes clinicians credentialing and recredentialing applications; monitors applications and follows-up as needed.

· Verifies, researches, and responds to telephone and written inquiries from clinicians and other departments, pertaining to provider participation and credentialing status.

· Compiles and maintains current and accurate data for all providers.

· Maintains copies of current state licenses, DEA Certificates, malpractice coverage and any other required credentialing documents for all clinicians.

· Maintains HIPAA standard and confidentiality of protected information.

· Applies general guidelines in determining whether provider meets criteria and documentation deficiencies.

· Refers non-approved clinicians or questionable situations to Provider Relations Managers or Senior Management.

· Maintains knowledge of current health plans and agency requirements for credentialing providers.

· Creates and maintains clinician information on online credentialing databases and systems.

· Tracks license and certification expirations for all clinicians to ensure timely renewals.

· Ensures practice addresses are current with health plans, agencies, and other entities.

· Audits health plan directories for current and accurate clinician information.

· Makes certain all Medicaid providers are Fully Enrolled and are listed in the AHCA website with the correct Taxonomy that matches their specialty.

· Prepares and maintains reports on all credentialing activities required.

· Works with the health plans to coordinate all credentialing and recredentialing activities for the company owned medical centers and contracted affiliate providers.

· Maintains compliance with documentation standards for verification of clinicians credentialing requirements, including but not limited to, licenses, certifications, registrations, permits, educational degrees, internship, residency and association memberships and any related electronic systems and software.

· Coordinate with the PPSS Network Management team and HR to ensure all records are properly and confidentially kept with the National Practitioner Data Bank, CAQH, and the Utilization Review Accreditation Commission.

· Performs other related duties as assigned.

Required Qualifications for Credentialing Specialist:

· High school Diploma required, and College degree preferred.

· Minimum two (2) years of experience managing credentialing, privileging or similar healthcare professional verification and organization’s accreditation processes are required.

· Experience in insurance management is highly preferred.

· Credentialing Specialist (CPCS) preferred.

· Bilingual (English Spanish) preferred.

· Excellent communication and writing skills, including Microsoft office (Excel, Word, Power-Point).

· Very well organized individual able to multi-task and handle high stress situations.

· Excellent time management skills to manage multiple tasks simultaneously.

Next Steps:

If you’re interested in speaking in more detail, please apply today! We are scheduling interviews ASAP.

Job Type: Full-time

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Flexible spending account
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Medical specialties:

• Primary Care

Schedule:

• 8 hour shift
• Monday to Friday

Work setting:

• In-person

Application Question(s):

• What is your target salary range?
• What is the best number to call you at to schedule an interview?
• Do you have a minimum two (2) years of experience managing credentialing, privileging or similar healthcare professional verification and organization’s accreditation processes?

Language:

• Spanish and English (Preferred)

Ability to Relocate:

• Port Orange, FL: Relocate before starting work (Required)

Work Location: In person