provider credentialing specialist.
orlando , florida
posted today
job detailssummary
$20 - $23 per hour
temp to perm
associate degree
category healthcare support occupations
referenceAB4594108
job detailsREMOTE - MUST BE LOCAL TO ORLANDO, FL The Credentialing Specialist reports to the Network Operations Manager and is responsible for activities associated with credentialing or re-credentialing of network providers, including review of providers credentialing documentation, processing, loading providers into the tracking database system to ensure high quality standard are maintained.salary: $20 - $23 per hourshift: Firstwork hours: 8 AM - 5 PMeducation: AssociateResponsibilities
Collect and evaluate initial and re-credentialing applications from providers and submit them to credentialing specialists.
Support NCQA audits and ensure compliance with credentialing QA standards.
Review provider documentation for re-credentialing and report any issues to leadership.
Monitor credentialing cycles to ensure compliance with regulatory and accrediting agency standards.
Maintain communication with provider representatives regarding the credentialing status of their providers.
Follow up on non-compliant physicians and facilities, recommending corrective actions when necessary.
Prepare end-of-month reports to communicate credentialing committee outcomes to providers.
Assist with mailing credentialing applications and follow-ups as per policy timelines.
Handle incoming calls, prepare provider mail-outs, and manage special projects.
Maintain and file provider records, ensuring compliance with inventory procedures.
Set up and manage practitioner files, contracts, and key documents in the credentialing workflow.
Prepare provider grids and profiles for credentialing committee review.
Support meeting coordination, including managing deadlines, agendas, and compiling meeting materials.
Assist with meeting minutes, follow-up items, and documentation within one week of meetings.
Conduct follow-up activities after credentialing meetings, including notifying teams, sending welcome letters, and re-credentialing confirmations
Skills
Microsoft Office
Credentialing
NCQA
Report Preparation
Compliance
Communication
Health Insurance Policies
Administrative Duties
Qualifications
Years of experience: 5 years
Experience level: Experienced
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