Credentialing/Provider Enrollment Specialist | Managed Care & Corporate Development

Overview

Supporting the Network Behind Exceptional Care.

💻 Work Style: Hybrid (Onsite training for first 2 months, then hybrid schedule)

📍 Location: Gainesville, FL

🕒 FTE: Full-Time (1.0 FTE)

⏰ Schedule: Monday – Friday - 8:00 am to 5:00 pm

Verifies and authenticates the credentials of healthcare professionals to ensure compliance with regulatory standards. Coordinates with medical staff and external agencies to collect and review necessary documentation, maintaining accurate credentialing records, and monitoring expiration dates for timely renewals. Supports audit and accreditation processes by preparing reports and documentation, communicates credentialing requirements to stakeholders, and assists the credentialing committee with meeting coordination. Requires resolving discrepancies and following up on incomplete credentialing information to maintain data integrity and compliance.

This position works collaboratively with Managed Care, Credentialing, Revenue Cycle, Medical Staff, Operations, and IT teams to support provider onboarding, enrollment maintenance, payor reporting, and operational workflow coordination across the health system.

Responsibilities

Key Responsibilities

• Verifies and authenticates credentials of healthcare professionals.
• Coordinates with medical staff and external agencies for documentation collection and review.
• Maintains accurate credentialing records and monitors expiration dates.
• Supports audit and accreditation processes with reports and documentation.
• Communicates credentialing requirements to stakeholders.
• Assists the credentialing committee with meeting coordination.
• Resolves discrepancies and follows up on incomplete credentialing information.
  
  

Qualifications

Minimum Qualifications

• Associate’s or Bachelor’s degree in Healthcare Administration, Business Administration, or a related field required; equivalent work experience may be considered in lieu of education
• 3 years of experience in healthcare credentialing, provider enrollment, or medical staff services.
• Knowledge of healthcare regulatory requirements, credentialing standards, and accreditation processes.
• Experience managing credentialing documentation, primary source verification, and provider renewal processes.
• Strong organizational, communication, and record management skills.
• Ability to coordinate effectively with medical staff, providers, licensing boards, payers, and external agencies.
  

Preferred Qualifications

• Experience with delegated provider rosters, provider onboarding, and enrollment maintenance workflows
• Familiarity with PECOS, NPPES, Medicaid portals, Medicare enrollment processes, and commercial payor systems
• Knowledge of provider enrollment, delegated credentialing, provider directory maintenance, and payor loading processes
• Experience validating provider demographics, NPIs, TINs, practice locations, specialties, taxonomy codes, and participation records
• Familiarity with CMS, AHCA, NCQA, and delegated credentialing requirements
• Experience working within a large multi-site health system, academic medical center, or managed care environment
• Experience with credentialing or enrollment systems such as CredentialStream, MD-Staff, or related platforms