Credentialing Specialist

The Credentialing Specialist participates as an active component of the Revenue Cycle by coordinating Hospital and Physician Group provider credentialing and enrollment activities with all governmental and Managed Care payors. Dialogs with hospital service line administrators, managers, providers, agencies and health plans to ensure prompt completion of the credentialing process to ensure claim payment.

This individual must be able to function well and meet deadlines under stressful conditions, must be flexible and able to continually reorganize work to adapt to changing circumstances, able and willing to work with the Managed Care Coordinator or Designee in suggesting department workflows and resolutions. They must be able to manage a demanding work load as well as be flexible with regards to work hours, work well with others, willing to embrace a team environment, and have the ability to multi-task. Must have reliable transportation and be available to use it to pick up and deliver credentialing documents as needed.

• Associate’s degree or equivalent work experience.
• 2-5 years in a hospital Medical Staff Office or Physician group practice preferred.
• NAMSS certification preferred but not required.
• Excellent oral and written communication skills
• Ability to maintain multiple projects simultaneously
• Strong organizational skills
• Experience with computers, database and word processing essential.
• Previous experience in Managed Care credentialing and/or provider enrollments in governmental agencies.
• Ability to work professionally and effectively with Physicians, Office Managers, Hospital Management staff and Managed Care organizations.
• Must be flexible and a strong team player. Expected to assist other Team Members as needed.
• Must be a Florida Notary or earn Notary within 6 months of employment.
• Accurately populate the Credentialing database with detailed provider information related to credentials and enrollments.
• Document effective dates, expiration of licensure, DEA, provider numbers, etc. used in the billing process. Maintain provider file to include original documents.
• Retrieve documents as needed to maintain current provider credentials for distribution to credentialing agencies. Responsible for requesting updated documents from provider, management, or provider designee.
• Determine enrollment and credentialing needs for new providers, compile necessary documentation and submit for enrollments with Medicare, Medicaid, Tricare and others. Provide notice to contracted plans for initiation and completion of provider credentialing.
• Provide routine follow up on submitted documents to ensure timely enrollment/credentialing completion.
• Initiate notice to Physician Services or other billing services requiring information on new and leaving providers, par effective dates, provider numbers used in billing and other information necessary to the Revenue Cycle.
• Provide support to providers and management staff as it relates to provider enrollment and credentialing via telephone, email or in person. Assists in investigation and resolution of claims issues attributed to enrollment.
• Prepare necessary reports for management staff for enrollment status, provider rosters for managed care and others as may be needed.
• Prepare necessary reports for management staff for enrollment status, provider rosters for managed care and others as may be needed.
• Meet with physicians, office management staff and Medical Staff office to retrieve documentation, secure approval of documents and signatures necessary for enrollments/ credentialing.
• Maintain high quality, positive relationships with physicians, Halifax managers, office management staff, and external enrollment/ credentialing contacts.
• Provide feedback to necessary PBFS staff as may be relayed by a contact for follow up as needed.
• Provide credentialing services as needed for maintenance of physician and hospital managed care contracts and re-credentialing.
• Secure and maintain a Florida State Notary certification.
• Other duties as assigned.

Halifax Health

Recognized by The Joint Commission as a Top Performer on Key Quality Measures, Halifax Health serves Volusia and Flagler counties, providing a continuum of healthcare services through a network of organizations including a tertiary hospital, community hospital, psychiatric services, a cancer treatment center with four outreach locations, the area’s largest hospice, a center for inpatient rehabilitation, primary care walk-in clinics, a walk-in clinic specializing in women’s health, two community clinics, three children’s medical practices, a home healthcare agency, and an exclusive provider organization. Halifax Health offers the area’s only Level II Trauma Center, Comprehensive Stroke Center, Pediatric Intensive Care Unit, Pediatric Emergency Department, Child and Adolescent Behavioral Services, complete Neurosurgical Services, OB Emergency Department and Level II Neonatal Intensive Care Unit that cares for babies born as early as 28 weeks. For more information, visit halifaxhealth.org.