Credentialing Specialist

Credentialing Specialist

Little Havana Activities and Nutrition Centers of Dade County, Inc. (LHANC)

Position Summary

Little Havana Activities and Nutrition Centers of Dade County, Inc. (LHANC) is seeking a highly organized and detail-oriented Credentialing Specialist to support the ongoing development and maintenance of its provider network. This role is responsible for managing all aspects of the provider credentialing and re-credentialing process in accordance with organizational, regulatory, and payer requirements.

The Credentialing Specialist will work collaboratively with internal departments—including Provider Relations, Claims, and Case Management—as well as external providers to ensure timely, accurate, and compliant credentialing outcomes. This position is primarily office-based and requires periodic local travel.

Essential Duties and Responsibilities

• Initiate, maintain, and oversee all credentialing and re-credentialing activities for assigned providers
• Review credentialing applications and supporting documentation to ensure completeness, accuracy, and regulatory compliance prior to submission
• Maintain comprehensive and organized provider files, including contracts, primary source verifications, licensure, insurance, and claims-related documentation
• Manage an active caseload of approximately 400–500 providers
• Serve as a subject matter resource for provider-related processes, including terminations, encounter submissions, authorization workflows, claims portal access and training, reporting, and payment inquiries
• Coordinate and conduct provider meetings and on-site visits, ensuring efficient scheduling and travel planning
• Facilitate provider education and training sessions, including large group presentations, and manage all associated logistics
• Identify and escalate credentialing or compliance risks that may impact a provider’s eligibility or ability to render services
• Respond to a high volume of provider inquiries while maintaining professional communication standards
• Ensure strict adherence to confidentiality requirements, organizational policies, and regulatory timelines

Minimum Qualifications

• Bachelor’s degree in a health-related field with one (1) year of credentialing or provider data experience
  OR
• High School Diploma or GED with a minimum of two (2) years of credentialing or provider data experience
• Bilingual in English and Spanish (required)

Preferred Qualifications

• Experience with Long-Term Care (LTC) and/or Managed Care Organizations (MCOs)
• Strong written and verbal communication skills
• Demonstrated ability to manage multiple priorities in a deadline-driven environment
• Proficiency in Microsoft Word, Excel, Outlook, and internet-based applications
• Strong analytical, organizational, and problem-solving skills
• Ability to maintain discretion and handle confidential information

Work Environment

• Primarily in-office with periodic local travel
• Fast-paced, deadline-driven healthcare environment

Equal Opportunity Employer

LHANC is an Equal Opportunity Employer and is committed to providing employment opportunities without regard to race, color, religion, creed, national origin, gender, age, disability, veteran status, genetic information, or any other protected classification in accordance with applicable laws.