Job Description

At BayCare, we are proud to be one of the largest employers in the Tampa Bay area. Our network consists of 16 community-based hospitals, a long-term acute care facility, home health services, outpatient centers and thousands of physicians. With the support of more than 30,000 team members, we promote a forward-thinking philosophy that's built on a foundation of trust, dignity, respect, responsibility and clinical excellence. BayCare is currently in search of our newest Team Member who is passionate about providing outstanding customer service to our community. We are looking for an individual seeking a career opportunity with one of the largest employers within the Tampa Bay area. Position Details + **Location:** Remote (Must reside in the state of Florida) + **Status:** This is a full-time position. + **Shift:** 8:00 AM to 5:00 PM (may vary) + **Days:** Monday - Friday The Credentialing and Provider Enrollment Specialist Senior will work in a remote role. Responsibilities: + Responsible for coordinating and managing all credentialing and provider enrollment activities for BMG providers. + Responsible for tracking a BMG provider's onboarding from recruitment, contracting, credentialing, provider enrollment and transitions in coordination with other departments throughout the BayCare Health System. + Responsible for ensuring that quality measures for the credentialing process are met for BayCare providers including providers with BayCare Medical Group (BMG), BayCare Behavioral Health (BBHA), BayCare Urgent Care (BUC), Telemedicine, EAP, and other independent/affiliated providers. + Ensures providers remain compliant with all licensing and board requirements and provides hands on assistance to providers to ensure renewals are processed seamlessly. + This includes partnering with the provider to ensure completion of all files and preparing the provider to navigating the appropriate approval processes including credentialing by the appropriate Credentialing Committee and for those that require them, obtaining hospital credentialing/privileges at one or more BayCare hospitals. + Assists with preparing files for review by the Credentialing Committee. Confirms providers remain compliant with all licensing and board requirements (expirables management) and processes provider applications for renewals reappointments. + Enrolls and maintains managed care enrollment for providers by providing updates to the health plans/payors and resolves errors and issues by coordinating with the plans/payors, the CBO and the Managed Care contracting department. + This includes ensuring the provider's information is added to physician rosters with all plans/payors and applications are completed for all non-delegated plans/payors. Assists in the development of new quality standards and programs, recommends updates, documents processes and trains team members on new and revised quality standards. + Identifies issues and trends in quality measures and Credentialing Specialist performance and reports that information to the Supervisor and Manager. + Audits credentialing files and credentialing database updates completed by Credentialing Specialists and to ensure they meet NCQA, CMS, AHCA, State and Federal guidelines and regulations, as well as department policies. Assist in the NCQA Accreditation renewals and Managed Care plan NCQA and CMS audits. **Minimum Qualifications:** Education + **Required:** High School Graduate or Equivalent GED + **Preferred:** Bachelor's degree in Business Administrator or Health Care Administration Certifications + **Preferred:** Certified Provider Credentialing Specialist (CPCS) Experience + **Required:** includes 3 years credentialing in addition to preferred 1-year Managed Care experience. Why BayCare? Our network consists of 16 community-based hospitals, a long-term acute care facility, home health services, outpatient centers and thousands of physicians. With the support of more than 30,000 team members, we promote a forward-thinking philosophy that is built on a foundation of trust, dignity, respect, responsibility, and clinical excellence. Our team members focus on tomorrow by achieving personal and professional success today. That is why you will thrive in our forward-thinking culture, where we combine the best technology with compassionate service. We blend high-tech with high touch in ways that are advancing superior health care throughout the communities we serve. Equal Opportunity Employer Veterans/Disabled **Position** Credentialing and Provider Enrollment Specialist Sr **Location** US:Florida | Business and Administrative | Full Time **Req ID** 123412

Job Tags

Full time, Monday to Friday, Shift work,

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