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GA Foods
St. Petersburg, FL | Full Time
$54k-70k (estimate)
2 Months Ago
Credentialing Specialist
GA Foods St. Petersburg, FL
$54k-70k (estimate)
Full Time 2 Months Ago
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GA Foods is Hiring a Credentialing Specialist Near St. Petersburg, FL

Credentialing Specialist

This is a hybrid position located in St. Petersburg, Florida. Must be local to the Tampa Bay area and able to work on-site at our corporate location in St. Petersburg at least 3 days a week.

Basic Skills:

GA Foods is hiring an experienced Credentialing Specialist to join our team at our headquarters in St. Petersburg, FL. The ideal candidate will have a strong healthcare background. Prior experience with Managed credentialing and managing customer contract files. Great for employees who enjoy working steadily to ensure accuracy while making a significant contribution to a team. The position reports directly to the Chief Compliance Officer.

General Purpose of Job:

The Credentialing Specialist is responsible for the review, administration, coordination, preparation, compilation, delivery, and file maintenance of agreements with state Medicaid and Med-waiver programs, Managed Care Organizations, OAA-funded (Older Americans Act) programs, Child Nutrition and other Senior/At-Risk business. Will serve as Administrator and point of contact with key stakeholders on customer agreements, audits, and requests for proposals.

Essential Duties:

  • Completes and maintains all state Medicaid and Med-waiver program enrollments, certifications, and revalidations.
  • Completes and maintains all enrollments, certifications, and revalidations for all managed care contracts.
  • Assists with the administration of all contracts, Master Service Agreements, Provider Service Agreements, Amendments, Addendums, and SOWs.
  • Ensures new contracts and renewals are executed timely, and accurately with notary authorization, as applicable.
  • Monitors and maintains all State Medicaid enrollment and certifications are accurate and up to date.
  • Monitors and notifies the Sales Team 90 to 120 days in advance of the expiration of all MCO Contracts, Provider Service Agreements, and SOWs to ensure contracts/SOWs do not lapse.
  • Reviews Managed Care RFPs to ensure accuracy and completeness of RFP packet before submission to customers
  • Orders certificates of insurance and maintain all current insurance policy information
  • Ensures distribution of fully executed agreements to all departments, as needed.
  • Maintains library of Contract compliance policies, processes, Medicaid and MCO provider manuals and other internal documents for credentialing and provider enrollment
  • Assists with all payor audits and monitor audit findings
  • Participates in the implementation of new agreements
  • Participant in a corporate compliance team
  • Other duties as assigned by management

Degree, Certifications:

  • Bachelor's Degree in a related field or equivalent combination of education and 3-5 years of healthcare contract experience
  • Paralegal certification, or an additional 3-5 years of health care contract experience
  • Florida Notary

Preferred Skills & Experience:

  • Healthcare Contract experience - required
  • Strong organizational skills, communication skills, and attention to detail
  • Prior experience with legal and regulatory terminology and requirements regarding contracts and RFPs
  • Advanced Computer Skills: MS Office Suite (Word, Excel, Outlook, PowerPoint), PDF editor

Physical Requirements:

Prolonged periods of sitting at a desk and working on a computer.

Diversity and Inclusion:

We believe in diversity of thought and bringing together other traits and characteristics that make an individual bring a unique experience to GA Foods. We strive to foster an inclusive environment where behaviors and social norms ensure people are welcome.

Equal Opportunity Statement:

We offer equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

Job Summary

JOB TYPE

Full Time

SALARY

$54k-70k (estimate)

POST DATE

01/28/2023

EXPIRATION DATE

02/23/2023

WEBSITE

www.gafoods.com

HEADQUARTERS

Florida

SIZE

200 - 500

CEO

Kaitlyn Larrabee

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The following is the career advancement route for Credentialing Specialist positions, which can be used as a reference in future career path planning. As a Credentialing Specialist, it can be promoted into senior positions as a Compliance Manager - Healthcare that are expected to handle more key tasks, people in this role will get a higher salary paid than an ordinary Credentialing Specialist. You can explore the career advancement for a Credentialing Specialist below and select your interested title to get hiring information.

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If you are interested in becoming a Credentialing Specialist, you need to understand the job requirements and the detailed related responsibilities. Of course, a good educational background and an applicable major will also help in job hunting. Below are some tips on how to become a Credentialing Specialist for your reference.

Step 1: Understand the job description and responsibilities of an Accountant.

Quotes from people on Credentialing Specialist job description and responsibilities

A certified professional credentialing specialist ensures that staff members of a facility maintain licenses, training, and certifications based on federal and state law.

03/14/2022: Des Moines, IA

A credentialing specialist can have certificates that will prove useful to their field.

02/01/2022: Newark, NJ

Credentialing specialists also ensure that any services provided by medical facilities meet the required standards as set by state and federal government agencies.

02/21/2022: Evansville, IN

Credentialing specialists are part of an organization's administrative staff; they review medical policies, process contracts, and facilitate audit reports to validate that certified medical professionals comply with credentialing procedures.

02/01/2022: Las Cruces, NM

Credentialing specialists will also ensure that their employer meets state, federal and other regulations for quality of care.

01/18/2022: Pueblo, CO

Step 2: Knowing the best tips for becoming an Accountant can help you explore the needs of the position and prepare for the job-related knowledge well ahead of time.

Career tips from people on Credentialing Specialist jobs

Credentialing specialists can often find work with a high school diploma or the equivalent.

01/25/2022: Kingsport, TN

Some employers strongly prefer credentialing specialists who have a Certified Provider Credentialing Specialist (CPCS) credential.

03/01/2022: Parkersburg, WV

While an associate degree may not be required for a position as a credentialing specialist, some employers may prefer applicants with a two-year degree.

12/25/2021: Little Rock, AR

Make Use Of Advanced Software For Monitoring.

01/18/2022: New London, CT

Stay Updated with the Coalition for Affordable Quality Healthcare's Credentialing Program.

01/31/2022: Portsmouth, OH

Step 3: View the best colleges and universities for Credentialing Specialist.

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