The Credentialing Specialist is responsible for maintaining active status for all providers by successfully completing initial and subsequent recredentialing packages as required by network.
 
This position is also responsible for maintaining all provider files for network compliance by ensuring all credentialing records comply with regulatory and accrediting standards.
 
This role will work hybrid (two days per week) out of our Jacksonville, Florida office.

Manage Credentialing /Recredentialing Process
- Data entry of providers into credentialing software
- Roster providers in CAQH
- Work directly with provider/practice to obtain any missing documentation
- Review and ensure credentialing files are complete and accurate from CVO for Director review
- Establish and maintain positive rapport with providers and practices
- Ensures practice addresses are current with health plans, agencies and other entities
- Maintains knowledge of current health plan and agency requirements for credentialing providers
 
Ongoing Monitoring
- Tracks license, certification, and liability insurance expirations for all providers to ensure timely renewals
- Review monthly State License monitoring via Licensing Board websites
 
 Other
- Participates in weekly team calls
- Assists management in regulatory, accreditation, and health plan audits as requested
- Utilizes and reviews system data for recruitment opportunities
- Performs other related duties as required and assigned

- Minimum 1-2 years credentialing experience in a medical practice
- Knowledge of Credentials Verification Organization (CVO) platforms
- Knowledge of CAQH system and applications
- Knowledge of CMS and NCQA standards

- Proficient with Windows, MS Office, Outlook and Internet Explorer
- Detail oriented with good organizational skills
- Plans and prioritizes to meet deadlines
- Excellent customer service skills; communicates clearly and effectively
- Works cooperatively in a team atmosphere
 
Preferred Qualifications
- Certified Provider Credentialing Specialist (CPCS) preferred
 
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