Managed Care Credentialing Specialist

CHC follows the CMS requirements which requires all team members to obtain a COVID-19 vaccination.

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" in 2018, 2019, 2020, 2021 and 2022.
  • Awarded "Top 100 Workplaces for Growing Families" by Orlando Sentinel.
  • Modernized and attractive health centers, that patients love.

Job Summary:

Responsible for performing credentialing for all licensed providers and Managed Care Organizations (MCOs) in accordance to departmental policies, procedures, accreditation standards and state and federal requirements.

Primary Responsibilities and Specific Duties:

  • Provider credentialing
  • Meets with new providers to explain the Managed Care credentialing documents, process and requirements.
  • Prepares and reviews provider credentialing applications to ensure the timely completion and submission of applications.
  • Responsible for gathering all information contained in the credentialing application. Ensures the accuracy of information and identifies and resolves any potential issues.
  • Responsible for the full cycle provider enrollment/re-enrollment to the various MCOs including follow up to ensure providers are fully credentialed.
  • Submits credentialing applications to the appropriate MCOs in a timely manner and follows up on all pending provider MCO applications until the provider is fully credentialed.
  • Assists providers in obtaining their login information for various websites including NPI- PECOS, CAQH, Medicaid, CMS, PedICare.
  • Maintains NPPES, CAQH, NPI provider profiles current and accurate.
  • Ensures accurate and timely entry of provider demographics for online web portals.
  • Completes Medicaid and Medicare enrollment and reenrollment processes.
  • Maintains a database of internal reports (Managed Care Tables, etc.) for status updates on provider Managed Care application submissions.
  • Sends provider termination of participation letters to MCOs within the specified time.
  • Actively participates in internal and external MCO meetings.
  • Assist with Meaningful Use attestations.
  • Assists with NPI, CAQH, NCPDP Pharmacy profile maintenance.
  • Performs other duties as assigned.

Qualifications:

Education:

  • Bachelor's degree in healthcare or business field or equivalent preferred.

Experience:

  • At least 2 years of experience in a managed care or credentialing environment preferred.
  • Proficient in Microsoft Office products (Outlook, Excel and Word).

Certification/Licensure:

  • Certified Provider Credentialing Specialist (CPCS) preferred.
  • Current Florida Notary License, or must be obtained within the first 90 days of employment.

Special Skills:

  • Strong communication, follow up and organizational skills.
  • Maintains confidentiality of all clinical and corporate data.
  • Bilingual (Spanish) skills preferred.

Other requirements:

  • Must be self-motivated with a high attention to detail, strong written and verbal communication skills, strong customer focus and interaction.
  • Ability to keep multiple requests moving forward and the ability to easily adjust to changing priorities.
  • Strong knowledge of HIPAA Security & Privacy requirements.
  • Able to work flexible hours as needed.
  • Required to travel to all CHC centers as required.