Credentialing and Enrollment Specialist

Job Description

Job Description

Position Summary

Primary responsibility of a Credentialing & Enrollment Specialist is to gather, review and process initial credentialing and re-credentialing information/data to ensure that all medical and dental providers at Tampa family Health Centers, Inc. (TFHC) are properly trained, licensed and certified as mandated by state and federal regulations. Also process enrollment application for participation into the various state and governing bodies.

Essential Duties & Functions

• Acts as a liaison between medical staff, administration, and healthcare plans; meet with providers to collect and review credentialing data

• Process Medicaid, PECOS/Medicare and CAQH

• Maintain data for all providers and track the expiration of certifications and licenses, ensuring the providers update their certification and/or licensure timely

• Ensure that all credentialing files are completed accurately and timely for Board review/approval

• Process new applications for provider privileges to TFHC

• Process credentialing and re-credentialing applications for all providers that will include reviewing resumes, conducting background checks, contacting licensing boards, reviewing license applications, obtaining educational information, and securing references

• Sets up and maintains provider information in an online credentialing database system

• Strict adherence to all HIPAA, TFHC, state, federal and accreditation agency rules, and regulations

• Support the Mission, Vision and Values of TFHC

• Accurate and timely completion of other duties, as assigned

• Keep up to date on medical licensing and certification requirements; understand current healthcare law, rules, and regulations

• Other duties as assigned by supervisor.

Required Education, Certifications, Licenses, & Training

• High school diploma, or equivalent

• Bachelor’s Degree or equivalent related work experience, preferred

Required Years of Experience

• Minimum 3 years credentialing, provider & facility enrollment experience

Required Knowledge, Skills, and/or Abilities

• Medicaid, PECOS/Medicare and CAQH

• Detail oriented, an organized decision maker with the ability to work both independently and in teams

• Strong communication skills, both written and oral

• Proficient in the use of the Microsoft Suite of products such as Word, Excel, and Outlook