AdventHealth Careers for Veterans

Job Information

AdventHealth Credentialing Specialist - Managed Care in MAITLAND, Florida

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.

We are an equal opportunity employer and do not tolerate discrimination based on race, color, creed, religion, national origin, sex, marital status, age or disability/handicap with respect to recruitment, selection, placement, promotion, wages, benefits and other terms and conditions of employment.

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