Credentialing Specialist

Description We are offering a position in Lutz, Florida, for a Credentialing Specialist who will be integral to our healthcare operations. This role involves handling all aspects of the credentialing, recredentialing, and privileging processes for our medical providers, clinics, and facilities. The selected candidate will ensure that our providers are properly credentialed, appointed, and privileged with health plans, hospitals, and patient care facilities. This role offers a contract employment opportunity.Responsibilities: Process initial credentialing and re-credentialing applications with precision. Screen practitioners’ applications and supporting documents to verify their eligibility. Identify discrepancies in information and conduct follow-ups as necessary. Maintain the upkeep of internal and external databases such as CAQH, PECOS, NPPES. Provide assistance to patients with credentialing inquiries and respond to health plan providers' inquiries. Ensure that health plans have appropriately processed requests and that provider information is correctly displayed on the health plans website. Conduct audits of Health Plan Directory and manage Medicare & Medicaid enrollment and revalidation. Perform provider roster reconciliation and manage initial and reappointment of hospital privileges. Provide internal and external support for health plan issue resolution. Utilize ATS - Asynchronous Transfer Mode, Banner Ads, CRM, Management System, McKesson, and Compliance software to manage credentialing processes and documentation. Requirements Proficiency in ATS (Asynchronous Transfer Mode) Experience with Banner Ads creation and management Proficient with CRM (Customer Relationship Management) systems Familiarity with Management Systems Knowledge of McKesson software Strong understanding of compliance regulations and standards Experience with the Council for Affordable Quality Healthcare (CAQH) Previous experience in Credentialing role Understanding of Credentialing Processes Excellent documentation skills and attention to detail Strong communication and organizational skills Ability to work under pressure and meet deadlines Ability to handle sensitive information with discretion and confidentiality. Robert Half is the world’s first and largest specialized talent solutions firm that connects highly qualified job seekers to opportunities at great companies. We offer contract, temporary and permanent placement solutions for finance and accounting, technology, marketing and creative, legal, and administrative and customer support roles.Robert Half works to put you in the best position to succeed. We provide access to top jobs, competitive compensation and benefits, and free online training. Stay on top of every opportunity - whenever you choose - even on the go. Download the Robert Half app (https://www.roberthalf.com/us/en/mobile-app) and get 1-tap apply, notifications of AI-matched jobs, and much more.All applicants applying for U.S. job openings must be legally authorized to work in the United States. Benefits are available to contract/temporary professionals, including medical, vision, dental, and life and disability insurance. Hired contract/temporary professionals are also eligible to enroll in our company 401(k) plan. Visit roberthalf.gobenefits.net for more information.© 2024 Robert Half. An Equal Opportunity Employer. M/F/Disability/Veterans. By clicking “Apply Now,” you’re agreeing to Robert Half’s Terms of Use (https:///www.roberthalf.com/us/en/terms) .