A career at Community Health Centers offers a unique opportunity to join a team that makes a real impact in our community every day, by improving individuals' health while enhancing their quality of life.

Top Reasons to Work at Community Health Centers

• No weekends for the majority of our centers, 10 Paid Holidays and early Fridays
• A great benefits package that includes healthcare coverage, paid time off, paid holidays, retirement plan, and more.
• Competitive compensation with advancement opportunities and tuition / training reimbursement.
• Awarded "Best and Brightest Companies to Work for in the Nation" for 5 consecutive years.
• Awarded "Top 100 Workplaces for Growing Families" by Orlando Sentinel.
• Modernized and attractive health centers, that patients love.

Job Summary:

The Credentialing Coordinator is responsible for ensuring organizational compliance with Credentialing and Human Resources Policies, applicable federal, state, local and regulatory requirements. This position facilitates all aspects of credentialing, including initial appointment, reappointment, monitoring, and privileging for all Licensed Independent Practitioners (LIP), Other Clinical Licensed Practitioners (OCLP), and Other Clinical Staff (OCS).

In this role, the Credentialing Coordinator exercises significant discretion and independent judgment in interpreting and applying policies and regulations. The Credentialing Coordinator plays a critical role in supporting the general business operations of CHC in making key decisions regarding compliance and credentialing standards.

This position requires a comprehensive understanding of credentialing standards and the ability

Primary Responsibilities and Specific Duties:

• Developing and implementing complex credentialing processes and procedures requiring a high level of responsibility and requires significant discretion and independent judgement.

• Reviews and maintains the confidentiality of information and materials that may include sensitive or adverse information including Personally Identifiable Information (PII).
• Develops, analyses, and summarizes reports for the Credentialing Committee, Executive Leadership, Chief Medical Officer, and/or Chief Dental Officer.
• Develops and implements recommendations for process and procedure changes based on analysis and evaluation.
• Conducts comprehensive provider credentialing and re-credentialing, including performing Primary Source Verifications.
• Monitors and manages the status of credentialing applications and requested information applying proactive problem-solving regarding the prioritization and follow-up of applications.
• Coordinates and facilitates Credentialing Committee meetings ensuring all requirements are completed in a timely manner.
• Responsible for all verified information and prepares and presents credential files for:
  • Presentation to the VP/Chief Medical Officer, VP/Chief Dental Officer, and Chiefs
• Credentialing Committee
• Board of Directors
• Disseminate information to other CHC departments as required.
• Coordinates with Providers to facilitate the hospital privilege initial and reappointment process by Specialty.
• Reviews and processes requests for changes in clinical privileges and staff changes through the appropriate committees. Maintains accurate records of all committee decisions and ensures updates are completed in a timely manner.
• Sends timely notifications to staff members regarding upcoming expiration of appointments. Tracks and follow-ups on the completion and return of reappointment profiles.
• Oversees the credentialing process for new and existing Providers, verifying qualifications, licensure, and certifications.
• Develops the Provider Contracts.
• Draft, review, and finalize Provider Contracts, ensuring compliance with organizational policies and legal requirements.
• Executes the initial Contracts and manages the renewal process, maintaining accurate records and timeliness.
• Oversees and maintains the background records of healthcare Providers as required by the Agency for Health Care Administration (AHCA).
• Liaison between Managed Care and Credentialing Department for providers AHCA backgrounds (initial and renewals) and separations of employment.
• Facilitates Credentialing training session during the Management Essentials program, providing comprehensive training and guidance to management staff.
• Manages the Basic Life Support (BLS) program, ensuring all clinical staff are certified and maintaining their credentials.
• Conducts ongoing monitoring of license status and state and federal sanctions for both contracted and non-contracted Providers and clinical staff. Investigates any discrepancies or issues related to licensure and sanctions, ensuring compliance requirements are met.
• Performs continuous monitoring of Medicare/Medicaid sanctions, Florida suspended and ineligible Providers, and various Medical Board license status issues.
• Manages the renewal process for all licensed clinical staff, ensuring timely submission and adherence to all licensing requirements. Maintains accurate records of all professional licenses and renewal dates.

• Responsible for ensuring compliance with complex policies, regulatory standards, and business operations.
• Acts as the liaison with Providers, clinical staff, and external sources to independently gather and verify necessary credentialing information. This role requires significant discretion and judgement in evaluating the accuracy and completeness of information, resolving discrepancies, and ensuring compliance with all regulatory and organizational standards.

Qualifications:

Education:

• High school degree required.
• Associate's degree preferred.

Experience:

• Minimum of two (2) years' Credentialing and Privileging experience in a healthcare setting required.
• Provider enrollment/credentialing software required.

Certifications/Licensure:

• Certified Provider Credentialing Specialist preferred.

Special Skills:

• Strong organizational skills and attention to detail.
• Advanced written and verbal communications.
• Proficient in data management and record-keeping.
• Strong analytical and decision-making skills.
• Ability to meet deadlines and prioritize, along with good organizational skills.
• Computer skills (Microsoft Office, emphasis on Word and Excel).
• Ability to interpret and resolve complex problems.
• Excellent time management and organizational skills.
• Proficiency in using notification and tracking systems.