Medical Credentialing

North Miami Beach

Full Time

Positions Open: 1

A credentialing specialist is responsible for all aspects of the credentialing, recredentialing and privileging processes for all medical providers who provide patient care at American Vision Group. The primary job is ensuring providers are credentialed, appointed, and privileged with health plans, hospitals, and patient care facilities. Maintain up-to-date data for each provider in credentialing databases and online systems; ensure timely renewal of licenses and certifications.

ESSENTIAL FUNCTIONS INCLUDE BUT ARE NOT LIMITED TO:

  1. 1. Compiles and maintains current and accurate data for all providers.
  2. Completes provider credentialing and recredentialing applications; monitors applications and follows-up as needed.
  3. Maintains copies of current state licenses, DEA certificates, malpractice coverage and any other required credentialing documents for all providers.
  4. Maintains corporate provider contract files.
  5. Maintains knowledge of current health plan and agency requirements for credentialing providers.
  6. Sets up and maintains provider information in online credentialing databases and system.
  7. Tracks license and certification expirations for all providers to ensure timely renewals.
  8. Ensures practice addresses are current with health plans, agencies, and other entities.
  9. Processes applications for appointment and reappointment of privileges to ASC and hospitals.
  10. Tracks license, DEA, and professional liability expirations for appointed ASC providers.
  11. Maintains ASC appointment files, and information in credentialing database.
  12. Audits health plan directories for current and accurate provider information.

 

ADDITIONAL RESPONSIBILITIES:

  1. Maintains confidentiality of provider information.
  2. Provides credentialing and privileging verifications.
  3. Performs other duties as assigned.

 

QUALIFICATIONS:

Education:

  1. High school diploma or equivalent.
  2. Associate degree preferred.

Certification/Licensure: Certified Provider Credentialing Specialist (CPCS) preferred.

Experience:
Two years of relevant credentialing experience
Two years of contracts negotiation experience