Medical Staff Credentialing Specialist, Sr. jobs in Hialeah, FL
Medical Staff Credentialing Specialist, Sr. processes credentialing and recredentialing applications for health care providers. Mails, reviews, and verifies credentialing applications. Being a Medical Staff Credentialing Specialist, Sr. loads and maintains provider information in an online credentialing database system. Tracks license and certification expirations for medical staff to ensure timely renewals. Additionally, Medical Staff Credentialing Specialist, Sr. handles and resolves inquiries regarding credentialing information, process, or status. May provide guidance or expertise to less experienced specialists. Requires a high school diploma. May require Certified Provider Credentialing Specialist (CPCS). Typically reports to a supervisor. The Medical Staff Credentialing Specialist, Sr. works independently within established procedures associated with the specific job function. Has gained proficiency in multiple competencies relevant to the job. To be a Medical Staff Credentialing Specialist, Sr. typically requires 3-5 years of related experience. (Copyright 2024 Salary.com)
Recently Added Medical Staff Credentialing Specialist, Sr. jobs
Credentialing Manager
- Chen Medical
-
Miami, FL
FULL_TIME
- Company DescriptionChenMed is transforming healthcare for seniors. We provide big answers to big problems in health care delivery.ChenMed is a full-risk primary care market leader with an innovative philosophy, unique physician culture and end-to-end customized technology. These things allow us to provide world-class primary care and coordinated care to the most vulnerable population – moderate- to low-income seniors who have complex chronic diseases.Through our innovative operating model, physician-led culture and empowering technology, we are able to drive key quality and cost outcomes that create value for patients, physicians and the overall health system.Our model allows us to practice medicine the way it should be practiced. By recruiting focused physicians and reducing their doctor-to-patient ratios, we increase patients’ “face time” during each monthly appointment and help foster stronger doctor-patient relationships. Our model also drives and enhances compliance with treatment plans.As a result of our efforts, our patients realize lower hospital admissions. Their overwhelming response to our approach is reflected in our aggressive, organic growth and net promoter scores in the low to mid 90s, which is unheard of in any industry. Read more about our results and the value of the ChenMed model.As a company, we are making a difference in the lives of seniors and the health care system overall.Job DescriptionThe Credentialing Manager is responsible for managing a team of credentialing professionals and is accountable for systems and processes that ensure compliance with organizational credentialing policies and procedures, and compliance with the credentialing requirements of our health plan partners, and related regulatory and accrediting agency requirements. This individual will oversee the initial and ongoing application process for all clinicians and is responsible for: maintaining the organization’s credentialing databases and online systems, maintaining up-to-date credential files, and managing all health plan enrollments and reappointments, as well as, managing all initial and ongoing applications for medical staff privileges at ChenMed designated facilities. Primary Duties and Responsibilities:• Ensure compliance with ChenMed’s credentialing and recredentialing policies and procedures, and compliance with state, federal, accreditation and health plan credentialing requirements.• Collaborate with leadership on policy development and standardization of criteria / processes across the organization.• Maintain and ensure up-to-date credentialing files.• Responsible for the accuracy and integrity of credentialing files, credentialing database and reporting systems.• Monitors external credential databases, including CAQH, PECOS and other regulatory agencies, to ensure data is updated and ready for quick retrieval and use by interested parties.• Ensure credentialing files are complete before presentation to Credentialing Committee.• Provide consultation to Credentialing Committee / leadership on issues related to consideration of clinician credentials and reappointments.• Oversee compliance with health plan requirements related to delegated credentialing agreements and credentialing file audits.• Oversee processes and reviews (including ensuring resolution) all reports related to adverse actions such as sanctions, licensure actions or limitations, and credentialing-related complaints.• Interview, hire and train new staff on credentialing and recredentialing policies and procedures; also provides ongoing training as needed regarding new guidelines or updated processes / policies.• Daily monitoring of employee’s workload and various credentialing work streams (e.g. onboarding, credentialing, pharmacy, medical staff privileging, Medicare/Medicaid enrollments, Credentialing Committee meetings, health plan enrollments, etc.). • Play an important role in making decisions regarding employee’s performance issues such as the need for disciplinary counseling, performance documentation and/or termination.• Conducts periodic audits of credentialing files and staff work-product.• Oversees initial applications and reappointments for Medicare / Medicaid enrollment, hospitals, surgical centers and managed care entities for assigned divisions. • Develops and provides regular reports and presentations concerning the operation and progress of the credentialing functions, including activity related to approvals, denials and / or appeals.Other responsibilities may include:• Monitor renewals of licensure and other documents subject to expiration, and ensures updates are forwarded to facilities and healthcare partners as renewals are received.• Oversee and coordinate health plan office site visits.• Work with leadership to identify and implement best practices related to credentialing.• Responds to facilities and health plan inquiries, interfaces with internal staff and external customers on day-to-day credentialing issues.• Collaborates with leadership on submitting and maintaining up-to-date health plan rosters.• Responsible for management and supervision of credentialing staff / team.• Upon request of supervisor, attends meetings with payer representatives to address outstanding issues.• Respond to internal / external request for credentialing and licensing status.• Develop reports to present to the leadership staff as requested.• Other activities as outlined in the credentialing and recredentialing policies and procedures.• Other duties as assigned and modified at manager’s discretion.Qualifications• Bachelor’s degree in business administration or health care related field required. • Strong understanding and use of web-based credentialing applications. Experience with MDStaff preferred.• Working knowledge of NCQA, AAAHC, JCAHO, AOA, URAC and other applicable accreditation and regulatory standards• Database management skills including querying, reporting, and document generation.• Five to Seven (5-7) years of Credentialing experience required. • Two (2) year experience in a Lead/Management capacity required.• Certified Provider Medical Services Management (CPMSM) / Certified Provider Credentialing Specialist (CPCS) Certification preferred (Required to obtain certification within 6-12 months of hire).Additional Information• Advanced knowledge of Microsoft Office Software (Excel, Access, and Word), database administration and scanning applications.• Strong organizational, verbal and written communication skills.• Ability to work effectively with staff, physicians and external customers.• Ability to work independently with limited supervision.• Multi-tasking and knowing how to set priorities. • Fluent in English. EDUCATION / SPECIALIZED KNOWLEDGE REQUIREMENTS:
- 1 Month Ago
Travel ASCP/AMT - Travel Med Tech - Medical Technologist
- Focus Staff Services
-
Key West, FL
OTHER
- OverviewWe currently have a client in Key West, FL looking for a Medical Technologist (Traveling Medical Technologist)Focus Staff is seeking a traveling Certified Medical Technologist, who is responsi...
- 1 Month Ago
Assembly Technician 2023-32712
- Apollo Retail Specialist
-
Key West, FL
PART_TIME
- Can’t stand being stuck behind a desk? Like working solo? Good with your hands? We have the perfect job for you as a Service Technician!Go store to store and work independently to keep the furniture d...
- 13 Days Ago
SUPV Intelligence Specialist (Staff Management)
- US Joint Activities
-
Key West, FL
FULL_TIME
- Duties Liaison with Senior Level Officials from Joint Activities organizations, Federal Agencies, and Host Nation partners from various Latin American countries to develop strategic partnerships. Cond...
- 7 Days Ago
Medical Insurance Verification Specialist TEMP
- MIAMI GLOBAL OBGYN LLC
-
Hialeah, FL
FULL_TIME
- MEDICAL INSURANCE VERIFIER MIAMI GLOBAL OBGYN LLC by Dr. Guillermo Kohn MD, is a growing OB-GYN independent office is hiring a full -time, bilingual (English/Spanish) INSURANCE VERIFIER SPECIALIST. Fo...
- 17 Days Ago
Travel Nurse RN - ICU/Critical Care - $1,797 to $1,852 per week in Key West, FL
- Focus Staff
-
Key West, FL
FULL_TIME
- Focus Staff is seeking a Intensive Care Unit Registered Nurse for a travel contract in Key West, FL. The ideal candidate will have at least 1 year of experience in a ICU setting. Contract Length: 13 W...
- 15 Days Ago
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0 Medical Staff Credentialing Specialist, Sr. jobs found in Hialeah, FL area
Credentialing Specialist (Provider Enrollment)
- Brightwing
-
Davie, FL
- Job Description Job Description This position is primarily responsible for the timely and compliant processing credentia...
- 4/23/2024 12:00:00 AM
Credentialing Specialist
- Billimd
-
Miami, FL
- Company Description At BilliMD, we specialize in simplifying medical billing and revenue cycle management. Our end-to-en...
- 4/22/2024 12:00:00 AM
Third Party Payor Credentialing Specialist
- Banyan Health Systems
-
Miami, FL
- Come and join and amazing established growing healthcare company with a 53 year history! Banyan Health Systems has been ...
- 4/22/2024 12:00:00 AM
Corporate Recruiter
- Banyan Health Systems
-
Miami, FL
- Banyan Health Systems has been serving Miami-Dade and Broward Counties since 1970. We provide quality, individualized ca...
- 4/22/2024 12:00:00 AM
Medicaid Credentialing Specialist
- Benjamin Douglas
-
Miami, FL
- The home care space is a multibillion dollar industry that has grown explosively since Covid arrived; baby boomers are g...
- 4/21/2024 12:00:00 AM
Credentialing Specialist
- BilliMD
-
Miami, FL
- Company Description At BilliMD, we specialize in simplifying medical billing and revenue cycle management. Our end-to-en...
- 4/20/2024 12:00:00 AM
Third Party Payor Credentialing Specialist
- Banyan Health Systems
-
Miami, FL
- Come and join and amazing established growing healthcare company with a 53 year history! Banyan Health Systems has been ...
- 4/20/2024 12:00:00 AM
Corporate Recruiter
- Banyan Health Systems
-
Miami, FL
- Banyan Health Systems has been serving Miami-Dade and Broward Counties since 1970. We provide quality, individualized ca...
- 4/20/2024 12:00:00 AM
About Hialeah, Florida
Hialeah ( /ˌhaɪəˈliːə/) is a city in Miami-Dade County, Florida, United States. With the population of 239,673 at the 2018 United States Census, Hialeah is the sixth-largest city in Florida. It is a principal city of the Miami metropolitan area, which was home to an estimated 6,012,331 people at the 2015 census. It is located west-northwest of Miami, and is the only place in the county, other than Homestead, Florida, to have its own street grid numbered separately from the rest of the county (which is otherwise based on Miami Avenue at Flagler Street in downtown Miami, the county seat).
Hialea...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Medical Staff Credentialing Specialist, Sr. jobs
$49,485 to $61,725
Hialeah, Florida area prices
were up 2.9% from a year ago
were up 2.9% from a year ago