Credentialing Specialist

About the position

The Credentialing Specialist at Nova Southeastern University (NSU) plays a crucial role in ensuring that healthcare providers meet the necessary qualifications and standards to deliver care. This position involves conducting thorough background investigations and research on applicants, completing credentialing and re-credentialing applications, and monitoring the status of these applications to ensure compliance with various regulatory agencies and third-party payers. The Credentialing Specialist is responsible for maintaining up-to-date data on each provider, including their education, training, licensing, and experience, ensuring that all information is current and accurate in the relevant databases and online systems. In addition to processing applications, the Credentialing Specialist applies for hospital privileges for providers and manages the reappointment process. This role also includes tracking license and certification expirations, ensuring timely renewals, and maintaining secure provider credential files. The specialist must stay informed about new policies and procedures from third-party payers and communicate these updates to the appropriate staff. Furthermore, the position involves assisting with managed care delegated credentialing audits and conducting internal file audits to ensure compliance with accreditation and regulatory standards. The Credentialing Specialist will also respond to inquiries from other healthcare organizations and collaborate with internal and external customers on credentialing and privileging issues. Participation in contracting functions is expected, requiring an understanding of contract terms. The role demands a commitment to excellent customer service and the ability to manage multiple projects efficiently while adapting to changes and meeting deadlines. Overall, this position is vital for maintaining the integrity and compliance of the credentialing process within the university's healthcare framework.

Responsibilities

• Conduct thorough background investigations and research on credentialing applications.
• Complete provider credentialing and re-credentialing applications and monitor their status.
• Process applications with respective agencies and third-party payers to ensure compliance.
• Perform credentialing of faculty and professional staff with various insurance carriers.
• Maintain up-to-date data for each provider in databases and online systems.
• Apply for provider hospital privileges and manage reappointments.
• Assist in maintaining Clinical Laboratory Improvement Amendments (CLIA) Certification.
• Track license and certification expirations for all providers.
• Maintain secure provider credential files and support review committees.
• Stay updated on new policies from third-party payers and ensure compliance with accrediting agencies.
• Assist with managed care delegated credentialing audits and conduct internal file audits.
• Respond to inquiries from healthcare organizations regarding credentialing issues.
• Participate in contracting functions and understand contract terms.

Requirements

• High School Diploma or GED with a minimum of four years of credentialing and/or contracting experience, or an Associate's Degree with two years of experience.
• Knowledge and understanding of the credentialing process and related accreditation requirements.
• Ability to work independently and manage multiple projects efficiently.
• Strong research and data analysis skills.
• Commitment to excellent customer service and effective communication.
• Proficient in MS Office applications and internet research.

Nice-to-haves

• Associate's Degree or 60 completed college credits hours.
• Experience with credentialing and/or insurance contracting in a medical setting.
• Experience with credentialing software.
• Certified Provider Credentialing Specialist (CPCS) certification.

Benefits

• Dental insurance
• Health insurance
• Retirement plan
• Tuition waiver
• Comprehensive benefits package