Credentialing Specialist

Are you ready to embark on a career journey that's more than just a job? At Tampa Family Health Centers (TFHC), we're redefining healthcare, and looking for Credentialing Specialist to be part of our dynamic team.

We're not just a healthcare organization; we're a community that thrives on innovation, compassion, and positive change.

And this is an onsite job at Tampa and not a remote job.

Position Summary:

Under the direction of the Credentialing Manager, the Credentialing Specialist performs services in compliance with Credentialing policies and procedures, the guidelines of the Health Resources and Services Administration (HRSA), Joint Commission (TJC), National Committee for Quality Assurance (NCQA), Centers for Medicare & Medicaid Services (CMS) as well as all other applicable State and Federal laws.

Essential Functions:

• Knowledge of credentialing, privileging, provider enrollment, and/or claims processing systems (Cactus, Modio, CredentialStream) and regulatory guidelines (TJC, NCQA, CMS).
• Serving as a liaison between medical staff, administration, and healthcare plans; maintaining data for all providers and tracking the expiration of certifications and licenses, ensuring the providers update their certification and/or licensure timely in an online credentialing software.
• Coordinating the receipt and review of completed provider applications while ensuring that facilities are in compliance with current standards.
• Maintaining medical provider files within the credentialing database with respect to information integrity and audits of expirable data.
• Processes credentialing and re-credentialing applications for all providers, including conducting primary source verification, collecting and validating documents to ensure the accuracy of all credentialing elements, assessing the completeness of information and qualifications relative to credentialing standards by reviewing resumes, conducting background screening, contacting licensing boards, reviewing license applications, obtaining educational information and securing references. Submitting and tracking provider enrollment applications to healthcare plans through the contract lifecycle.
• Manages time-sensitive and confidential documents and identifies critical issues/red flags to report to the manager.
• Ensures that all credentialing files are completed accurately and timely for Quality Improvement Committee & Board of Directors review/approval.
• Answers, researches, resolves, and documents provider calls involving various issues utilizing multiple information systems.
• Exercises sound judgment, interprets provider data and contracts and remains knowledgeable in company policies and procedures.

Knowledge and Experience:

• Strong knowledge of licensing and certifying bodies, managed care systems, and contract-related primary source verification activities.
• Minimum of six (6) months of administrative or clerical business office experience required.
• Minimum of six (6) months of experience in licensing, healthcare, or insurance strongly preferred.
• Certification or training in related areas is strongly preferred.
• Proficient in the use of the Microsoft Suite of products such as Word, Excel, and Outlook.

Education, Certification Training and License:

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