Job Description

Position Summary

We are seeking a Credentialing Specialist responsible for the administration and coordination of all credentialing, reappointment/recredentialing and delegated credentialing activities. Ensures the needs of medical staff and managed care offices are met through efficient processes, assuring compliance to accreditation standards, government agencies, as well as Orlando Health bylaws, rules & regulations.

*Health Plan Credentialing and Provider Enrollment experience preferred*

Schedule

Monday - Friday 8am-4:30pm

Location

1335 Sligh Blvd 3rd FL

Orlando, FL 32806


Responsibilities

Essential Functions

• Performs credentialing functions as outlined by Orlando Health management in accordance with established policy, procedures, and protocols.
• Performs timely and accurate primary source verification in addition to credentialing functions.
• Completes accurate and timely data entry of all credentialing activity into credentialing database.
• Provides exceptional customer service to physicians and physician office staff members as well as internal customers, such as members of other departments. Educates physicians and physician office staff on the credentialing process and maintains ongoing contact with these individuals throughout the process.
• Identifies trends and assists in the development of action plans for purpose of performance improvement. Evaluates processes in departmental policies & procedures and makes recommendations for changes to management. Develop and distribute reports as necessary utilizing credentialing database. Timely completion of all assigned duties.
• Maintains credentialing and reappointment/recredentialing files.
• Other duties as assigned
• Maintains reasonably regular, punctual attendance consistent with Orlando Health policies, the ADA, FMLA and other federal, state, and local standards.
• Maintains compliance with all Orlando Health policies and procedures.

Other Related Functions

• COMPLEXITY OF WORK: Requires critical thinking skills, decisive judgment, and the ability to work with minimal supervision. Must be able to work in a stressful environment and take appropriate action.
• Knowledge of medical credentialing and privileging procedures and standards.
• Knowledge of accreditations/government agencies standards and Orlando Health bylaws, rules & regulations.
• Assumes responsibility for professional growth and development.

Qualifications

Education/Training

• High school graduate or equivalent.
• Knowledge of medical terminology.

Licensure/Certification

• None

Experience

• Three (3) years' experience credentialing/privileging or;
• One (1) year of credentialing/privileging experience and/or two (2) years of clinical experience.
• Associate degree in business, health care, accounting or related field may be substituted for two (2) years of experience.
• Bachelor's degree in health, business or related field may be substituted for three (3) years of experience.
• Proficiency in Microsoft Word, Excel, Internet and significant proficiency in credentialing data system.

Job Tags

Work at office, Local area, Monday to Friday,

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