Credentialing Specialist I

Overview

Base pay range: $27.00/hr - $28.00/hr. Immediate need for a talented Credentialing Specialist I. This is a 06+ months contract opportunity with long-term potential and is located in FL (Remote). Job ID: 25-86770 Pay Range: $27 - $28/hour. Employee benefits include, but are not limited to, health insurance (medical, dental, vision), 401(k) plan, and paid sick leave (depending on work location).

Key Responsibilities

• We process requests from existing, already contracted groups for the entire state of Florida who are interested in adding new practitioners who have joined their group.
• The Credentialing Specialist will be part of the Credentialing Triage team.
• The candidate will be responsible for vetting the online requests received from existing providers, gathering the required credentialing documents, and submitting the request through our internal system.
• If missing information is identified, the specialist will reach out to our providers via email to request any missing information.
• The team currently consists of 11 credentialers, processing requests for all lines of business.
• Time management is crucial because if they request missing information, once the information is received, they will be required to complete the process promptly, while working on the new requests we receive in the mailbox from providers and through our system from internal customers.
• The idea is for the emails assigned to be worked from oldest to newest.
• They will create a practitioner folder in our S Drive where all the documents will be gathered and saved.
• If they can complete the process, the request is submitted through our internal system, and a communication to the provider is sent a notification stating that the process was completed.
• Missing information is tracked in our SharePoint.
• Perform credentialing and re-credentialing activities according to plan specifications and in compliance with NCQA standards.
• Communicate with professionalism with physicians, office managers, providers, and other third parties to secure needed information.
• Gather information for Credentialing Committee meetings.
• Process, track, and file credentialing applications within established standards.
• Generate and utilize reporting to support business functions.
• Ability to thrive in a fast-paced production environment while maintaining quality.

Key Requirements and Technology Experience

• Associate’s degree, or high school diploma/equivalent and 1+ years of data entry, customer service, medical office, provider data management, credentialing, or healthcare operations (i.e., claims processing, billing, provider relations, or contracting) experience, preferably in a managed care or insurance environment.
• Credentialing knowledge is helpful but not required, Excel, attention to detail, organizational skills, the ability to prioritize & pivot, communication skills, problem-solving, and working under pressure.
• NAMSS Credentialing Certification and knowledge of NCQA Standards are preferred for this role.
• Work under pressure, Time management, and communication skills are required for this role.

Our client is a leading Healthcare Industry and we are currently interviewing to fill this and other similar contract positions. If you are interested in this position, please apply online for immediate consideration. Pyramid Consulting, Inc. provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. By applying to our jobs you agree to receive calls, AI-generated calls, text messages, or emails from Pyramid Consulting, Inc. and its affiliates, and contracted partners. Frequency varies for text messages. Message and data rates may apply. Carriers are not liable for delayed or undelivered messages. You can reply STOP to cancel and HELP for help. You can access our privacy policy here. Remote Credentialing and Enrollment Specialist; Associate Specialist, Corporate Credentialing Fort Lauderdale, FL $1,500 - $3,800 4 days ago Greater Orlando $50,000 - $65,000 1 week ago We’re unlocking community knowledge in a new way. Experts add insights directly into each article, started with the help of AI. #J-18808-Ljbffr