Credentialing Specialist
On-siteOdessa, Florida, United States or Trinity, Florida, United States
Job Summary
Complete initial credentialing and recredentialing applications for physicians and advanced practice providers. Enroll providers with insurance companies and track license, DEA, board certification, and malpractice expiration dates. Coordinate hospital privileges and maintain credentialing databases while resolving issues that delay provider participation or reimbursement. Communicate with physicians, hospitals, and insurance payers to ensure compliance with CMS, Joint Commission, and payer requirements. Manage CAQH profiles, PECOS enrollment, and NPI registration using electronic credentialing systems. This role supports a private orthopedic surgeon's office, where knowledge of surgical credentialing and ambulatory surgery center operations is valuable.
Required Qualifications
- High school diploma or GED
- 1–3 years of provider credentialing experience in a physician practice, hospital, or healthcare organization
- Knowledge of provider enrollment for Medicare, and commercial insurance plans
- CAQH profile management
- PECOS enrollment
- NPI registration
- Hospital privileging and recredentialing
- Primary source verification
- Knowledge of CMS, Joint Commission, NCQA, and payer requirements
- Familiarity with provider contracts and malpractice documentation
- Excellent organization and attention to detail
- Strong communication and follow-up skills
- Proficiency in Microsoft Excel, Word, Outlook, and electronic credentialing systems
Desired Qualifications
- Associate or bachelor's degree in healthcare administration, business, or a related field
- Experience with orthopedic, surgical, or multispecialty practices
- CPCS (Certified Provider Credentialing Specialist) through NAMSS
- CPMSM (Certified Professional Medical Services Management) for more senior roles
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