Credentialing Specialist – Orlando – Full-time

Position:                      Credentialing Specialist

Department:                Central Billing Department

Dept. Director:             Director, Revenue Cycle Management

Supervisor:                 Director, Revenue Cycle Management

Location: Orlando, FL 32806

Job Summary:

The Credentialing Specialist is responsible for the timely and accurate completion of managed care and governmental payor credentialing and re-credentialing applications for Orlando Health Physician Associates’ physicians and allied health professionals.

Job Responsibilities:

  1. Ensures timely collection of all credentialing/re-credentialing related documentation required by managed care and governmental  payors in order to expedite and mitigate financial risk to the organization
  2. Ensures accurate completion of all credentialing/re-credentialing related applications required by managed care and governmental payors in order to expedite and mitigate financial risk to the organization
  3. Maintains responsibility for credentialing/re-credentialing for Ambulatory Surgery Center
  4. Escalates credentialing/re-credentialing issues to internal leadership in a timely manner and interacts with leadership to obtain prompt resolution
  5. Ensures credentialing information is communicated timely to all internal departments responsible for loading systems that support claims processing and collections for services rendered
  6. Interacts and communicates with physicians and numerous departments within Orlando Health to obtain information necessary for credentialing/re-credentialing completion
  7. Develops and fosters relationships with managed care plans, Medicare and Medicaid to facilitate timely credentialing
  8. Prepares for management use, bi-weekly progress reports providing a credentialing status for each physician
  9. Maintains accurate and current hard-copy credentialing files for Orlando Health Physician Associates physicians and allied health professionals
  10. Maintains accurate and current electronic status reports and files related to credentialing.
  11. Responsible for maintaining physician credentialing database and ensuring the integrity of data maintained
  12. Maintains current knowledge of state and federal government regulations that impact physician/hospital credentialing
  13. Remains knowledgeable of all NCQA requirements for physicians and hospitals in order to ensure that all requirements are met. If a physician or hospital does not meet these guidelines notifies applicable managers
  14. Maintains reasonably regular, punctual attendance consistent with Orlando Health Physician Associates’ policies, the ADA, FMLA and other federal, state and local standards
  15. Maintains compliance with all Orlando Health Physician Associates policies and procedures
  16. Works cooperatively in facilitating efficient and effective assistance to team members of the Central Business Office and Orlando Health Physician Associates physician practices
  17. Assists physicians and others as needed with all matters relative to Managed Care, Medicare, and Medicaid credentialing
  18. Develops and maintains a working knowledge of regulations, policies, and protocols as relates to credentialing with the above entities. Maintains confidentiality
  19. Provides administrative support to the Managed Systems team on an as needed basis.

Physical Requirements:

  1. Ability to operate a computer
  2. Ability to communicate verbally and in writing professionally
  3. Ability to hear and see

Educational/Experience Requirements:

  1. High School Diploma
  2. Two years of healthcare experience to include interaction with managed care plans and/or governmental payors

To apply send your resume and title of position to mburns@paof.com