Medical Staff Credentialing Specialist, Sr. jobs in Jacksonville, FL

Job Position:  Credentialing Specialist- Medical Pediatrics Office

Angel Kids Pediatrics is the largest Pediatric group in Jacksonville, FL, with 7 offices and 15 providers caring for more than 40,000 families in the greater Jacksonville area. Our practice is growing and is looking for a CREDENTIALING SPECIALIST at our Corporate office location.  

Classification: Hourly, Non-Exempt Full time

Supervisory Responsibilities: None

Qualifications

• Experience:
  • Billing, 2 years (Required)
  • Medical Credentialing, 4 years (Required)

Full Job Description

The Credentialing Specialist will be responsible for all aspects of medical credentialing and re-credentialing processes:

• Responsible for ensuring providers are credentialed, appointed, and privileged with health plans, hospitals and patient care facilities. Maintain up-to-date data for each provider in credentialing databases and online systems; ensure timely renewal of licenses and certifications.
• Responsible for payer contracts. Interprets contract language and terms and requests modifications as necessary. Maintain payer reference documents for clients. Established knowledge of payer requirements and business lines

Some of the essential functions of this role include the following:

• Credentialing, and/or privileging for practitioners and facilities as applicable
• Conduct research and provide summaries as requested for various provider types, facilities, or payer entities
• Tracking and maintenance of all supportive and required documents for facilities or practitioners
• Maintain and document activities for all assignments in credentialing software
• Effectively and professionally communicate with clients
• Create and maintain CAQH accounts
• Create and maintain NPPES/PECOS accounts

The ideal candidate will have the following background and experience:

• High school diploma or equivalent
• Knowledge of government/ Medicare/ Regulatory Agency requirements relating to credentialing
• Minimum five years’ experience in healthcare; including a background in billing.
• Minimum four years’ experience with credentialing and contracting
• Knowledge of medical practices, terminology and credentialing requirements
• Planning and project organization/administration skills
• Skill in exercising initiative, solving problems, executing timelines, and making decisions
• Ability to communicate professionally and appropriately with clients, managers, and co-workers
• Basic computer skills: MS Word, MS Excel, and MS Outlook
• Basic math skills
• Dependability
• Detail oriented
• Adaptable/flexible

If you possess the above qualifications, we invite you to submit your resume and apply. We will review all candidate submissions. Initial interviews will be telephonic. If invited, the second interview will be conducted in person.

Job Type: Full-time, hourly

Schedule:

• 8 hour shift
• Monday to Friday

Experience:

• Billing: 2 years (Required)
• Medical Credentialing: 4 years (Required)

Work Location:

• Angel Kids Pediatrics Jacksonville Corporate Office

Additional Duties

Travel:  Travel is primarily local during the business day. May be required to travel between offices as needed.

 EEO Statement 

Equal Employment Opportunity

It is the policy of AKP to provide equal employment opportunity to all employees and applicants for employment and not to discriminate on any basis prohibited by law, including race, color, sex, age, religion, ancestry, national origin, marital status, veteran status, or other legally protected group status. It is our intent and desire that equal employment opportunities will be provided in employment, recruitment, selection compensation, benefits, promotion, demotion, layoff, termination and all other terms and conditions of employment. AKP is committed to this policy and its enforcement.