Credentialing Specialist - Managed Care

Are you passionate about ensuring healthcare providers are properly credentialed and able to provide quality care to patients? Look no further! Orlando Health is seeking a motivated and detail-oriented Credentialing Specialist to join our Managed Care team. In this role, you will play a crucial role in ensuring our network of providers meet all regulatory and compliance standards, allowing us to deliver the best possible care to our patients. If you have a strong background in credentialing and a desire to make a positive impact in the healthcare industry, we would love to hear from you!

1. Conduct thorough and accurate credentialing and recredentialing for healthcare providers in compliance with organizational policies and regulatory requirements.
2. Verify and maintain accurate provider information, including licensure, certifications, and malpractice insurance.
3. Communicate with providers to obtain necessary documentation and resolve any credentialing issues in a timely manner.
4. Create and maintain provider files and databases, ensuring all information is up-to-date and organized.
5. Collaborate with internal teams, such as human resources and legal, to ensure all credentialing processes align with organizational standards.
6. Monitor and track expiration dates for provider credentials, ensuring timely renewals are completed.
7. Stay updated on changes in regulations and requirements related to provider credentialing, and make necessary adjustments to processes and procedures.
8. Assist in the development and implementation of credentialing policies and procedures.
9. Educate providers on credentialing requirements and assist in the onboarding process for new providers.
10. Maintain confidentiality and adhere to HIPAA regulations when handling sensitive provider information.
11. Serve as a liaison between the organization and outside agencies, such as insurance companies and accrediting bodies, to provide necessary credentialing information.
12. Participate in audits and reviews of the credentialing process to ensure accuracy and compliance.
13. Adhere to strict timelines and deadlines for credentialing activities.
14. Identify and report any potential compliance or regulatory issues related to credentialing.
15. Continuously evaluate and improve the credentialing process to enhance efficiency and accuracy.

According to JobzMall, the average salary range for a Credentialing Specialist - Managed Care in Orlando, FL, USA is between $45,000 and $65,000 per year. However, this can vary depending on factors such as experience, education, and the specific employer. Some employers may offer higher salaries for candidates with advanced credentials and/or extensive experience in managed care.

Orlando Health is a private, not-for-profit network of community and specialty hospitals based in Orlando, Florida. Orlando Health has award-winning hospitals, clinics and over 2000 physicians throughout Central Florida.