What are the responsibilities and job description for the Credentialing Specialist position at Clearwater Cardiovascular Consultants?
WHO WE ARE:
Clearwater Cardiovascular Consultants (CCC) has been providing the highest level of cardiovascular care to patients in the Tampa Bay region for over 50 years. CCC physicians and advanced practitioners represent some of the finest and most respected independent practitioners in the area. CCC provides a broad spectrum of interventional, diagnostic and preventive cardiovascular services, and offers patients comprehensive care backed by experience, expertise and technology.
Joining Clearwater Cardiovascular Consultants is about being part of something bigger. It’s about belonging to a community that believes in the wholeness of each person. Where you will be valued for who you are and the unique experiences you bring to our purpose-minded team. All while understanding that together we are even better.
We are seeking a dedicated Credentialing Specialist for our medical office.
Scope
In this role, you'll ensure clinicians are credentialed, enrolled, and maintained with insurance payers so they can deliver services without interruption or reimbursement delays. You'll serve as a key point of contact with insurance carriers while helping maintain compliance, accuracy, and operational efficiency.
What You'll Do
- Manage provider credentialing and payer enrollment from application through approval.
- Submit, track, and maintain credentialing applications, renewals, and supporting documentation.
- Serve as the primary contact for insurance payers, resolving credentialing, roster, and enrollment issues.
- Follow up with payers to verify application status, effective dates, and outstanding requirements.
- Maintain accurate provider records across credentialing systems and payer portals.
- Manage and attest provider profiles within CAQH.
- Verify and maintain NPI information through NPPES.
- Track credentialing deadlines, recredentialing cycles, and enrollment activity.
- Coordinate credentialing requirements for new hires and newly licensed providers.
- Review documentation for completeness, accuracy, and compliance.
- Monitor payer policy updates and communicate changes to internal stakeholders.
What We're Looking For
- Experience in provider credentialing, payer enrollment, healthcare administration, or a related healthcare support role.
- Knowledge of managed care credentialing and enrollment processes.
- Experience managing CAQH profiles and attestations.
- Familiarity with NPPES and NPI verification.
- Experience working with commercial insurance payer portals.
- Strong organizational skills with exceptional attention to detail.
- Ability to manage multiple priorities and deadlines in a fast-paced environment.
- Excellent written and verbal communication skills.
- Proficiency with Excel, Google Sheets, and tracking systems.
- Behavioral health experience and familiarity with NCQA standards are preferred.
It is the Policy of CVL to ensure equal opportunity to all Team members, applicants or any other covered persons in all employment matters, including but not limited to recruitment, hiring, placement, compensation, benefits, training, promotion, transfer. CVL does not discriminate against any qualified individual because of actual or perceived race (including traits associated with race, for example, hair texture and protective hairstyles such as braids, locks, and twists), color, creed, religion, age, national origin, ancestry, citizenship status, sex or gender (including pregnancy, childbirth, related medical conditions and lactation), gender identity or gender expression (including transgender status), sexual orientation, citizenship status, work authorization status.