Credentialing and Provider Enrollment Specialist

About the Role

BayCare is seeking a Credentialing and Provider Enrollment Specialist for a full-time remote position. This role is responsible for initiating and maintaining credentialing, managed care provider enrollment, and hospital privileges for BayCare physicians and providers. The ideal candidate must reside in the State of Florida.

Responsibilities

• Initiate and maintain credentialing, managed care provider enrollment, and hospital privileges in accordance with NCQA, CMS, AHCA, State and Federal guidelines, as well as Department Policies, to ensure compliance with credentialing standards.
• Complete primary source verifications and assess provider qualifications to ensure they meet BayCare's quality standards.
• Document all verifications and data in the credentialing database to produce credentialing files that meet BayCare's quality standards within required time frames.
• Ensure providers remain compliant with all licensing and board requirements and assist providers with renewals.
• Enroll and maintain managed care enrollment by providing updates to health/payor plans and resolve errors and issues by coordinating with the plans, the CBO, and the Managed Care contracting department.

Requirements

• High School Diploma or equivalent GED (required).
• Associate or bachelor’s degree (preferred).
• 1 year of experience in Credentialing or Managed Care.

Qualifications

• Certification as CPCS (Credentialing) (preferred).

Benefits

• Competitive total reward package including health, dental, and vision benefits.
• Paid time off.
• Tuition reimbursement.
• 401k match and additional yearly contribution.
• Yearly performance appraisals and team award bonus.
• Community discounts.

Schedule

• Full-time, non-exempt position.
• Shift: 8:00 AM to 4:30 PM (may vary).
• Days: Monday through Friday.

About 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 built on trust, dignity, respect, responsibility, and clinical excellence. Our team members focus on tomorrow by achieving personal and professional success today, thriving in a culture that combines advanced technology with compassionate service.