Credentialing Specialist Managed Care Full Time at AdventHealth

Date Posted: 7/31/2019

Job Snapshot

  • Job Schedule
    Full-Time
  • Location:
    Maitland, FL
  • Job Category
  • Date Posted:
    7/31/2019
  • Job ID:
    19012202
  • Job Family
    Managed Care
  • Travel
    No
  • Application Zone
    1-Shared Services
  • Organization
    AdventHealth Corporate

Job Description


Description
Credentialing Specialist – Managed Care AdventHealth Corporate
Location Address: 1051 Winderley Place Maitland, FL 32751
Top Reasons To Work At AdventHealth Corporate
  • Great benefits
  • Immediate Health Insurance Coverage
  • Career growth and advancement potential
Work Hours/Shift:
  • Full-Time, Monday – Friday
You Will Be Responsible For:

  • Coordinates, and monitors the review and analysis of practitioner applications and accompanying documents, ensuring applicant eligibility.
  • Conducts thorough background investigation, research and primary source verification of all components of the application file and ensures provider files are current and noted in detail in the system of record.
  • Achieves productivity standards as determined by management.
  • Identifies issues that require additional investigation and evaluation, validates discrepancies and ensures appropriate follow up.
  • Prepares credentials file for completion and presentation to the AHS Delegated Credentialing Committee (DCC) or other affiliated credentialing committees within AHS, including Clinically Integrated Network (CIN) committees ensuring file completion within time periods specified.
Qualifications
What You Will Need:
  • High school diploma or GED
  • Minimum 5 years of healthcare experience with 1 year directly related to hospital medical staff or managed care credentialing and/or provider enrollment.
  • Completed degree(s) from an accredited institution that are above the minimum education requirement may be substituted for experience on a year for year basis
  • NAMSS Certification as a Certified Professional Medical Services Manager (CPMSM) or Certified Provider Credentials Specialist (CPCS) or actively pursuing certification and secure within 1 year in the role.
  • Knowledge of related accreditation and certification requirements.
  • Knowledge of medical credentialing and privileging procedures and standards.
  • Database management skills including querying, reporting, and document generation.
  • Working knowledge of clinical and/or hospital operations and procedures.
 
Job Summary:
Responsible for coordinating, monitoring, and maintaining the credentialing and re-credentialing process. Facilitates all aspects of AdventHealth credentialing, including initial appointment, reappointment, expirables process of physicians and allied health professionals, and all other providers outlined in AHS policies, or related contracts. Ensures interpretation and compliance with the appropriate accrediting and regulatory agencies, while developing and maintaining a working knowledge of the statues and laws relating to credentialing. Responsible for the accuracy and integrity of the credentialing database system and related applications. Works under the supervision of the Centralized Verification Office (CVO) Manager.


This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances.

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