Credentialing Specialist

Description

POSITION SUMMARY:

The Credentialing Specialist is responsible for managing the full lifecycle of provider credentialing, recredentialing, and privileging for all medical providers delivering care across Cancer Center of South Florida locations. This role ensures providers are accurately enrolled, credentialed, and privileged with health plans, hospitals, and other patient care facilities in a timely manner. The Credentialing Specialist maintains accurate, up-to-date provider data across credentialing systems and trackers, and proactively manages renewals, expirations, and CAQH updates to ensure continuous compliance and uninterrupted billing.

CORE ESSENTIAL RESPONSIBILITIES:

• Prepare and submit credentialing and payer enrollment applications for new and existing providers, including initial enrollment, recredentialing, and mid-cycle updates.
• Manage hospital privileging applications and reappointments across applicable facilities.
• Maintain and update provider CAQH profiles, ensuring attestations are current and complete.
• Process provider demographic updates with payers, including address changes, tax ID updates, and panel status changes.
• Monitor application status across all active submissions and follow up with payers, hospital medical staff offices, and licensing bodies to keep things moving.
• Track expiration dates for licenses, certifications, DEA registrations, and payer enrollments, initiating renewals well ahead of deadlines.
• Maintain accurate and audit-ready provider records in the credentialing database and all applicable tracking systems.
• Serve as the primary point of contact for assigned providers, communicating proactively on status, outstanding requirements, and timelines without waiting to be asked.
• Collect required credentialing documentation from providers in a way that is organized, clear, and minimally burdensome.
• Escalate stalled or at-risk enrollments to the Director of Credentialing promptly with a clear status summary.
• Collaborate with Revenue Cycle, Recruiting, and Operations to coordinate enrollment timelines and resolve billing-related credentialing issues.

Requirements

REQUIRED EDUCATION & EXPERIENCE

• High school diploma or equivalent required; Associate’s or Bachelor’s degree in Healthcare Administration or related field preferred.
• 2+ years of experience in provider credentialing, payer enrollment, or a related healthcare administrative role.

REQUIRED CERTIFICATES, LICENSE OR REGISTRATION

• CPCS certification preferred 

REQUIRED KNOWLEDGE, SKILLS OR ABILITIES

• Knowledge of payer enrollment processes, CAQH, and hospital privileging requirements.
• Knowledge of credentialing software and payer enrollment portals.
• Skill in managing multiple deadlines simultaneously without sacrificing accuracy.
• Ability to communicate proactively and professionally with providers and internal stakeholders.
• Ability to identify problems early and escalate appropriately.
• Proficient use of Microsoft Office applications (Word, Excel, Access) and internet resources.