Credentialing Specialist (On-site)

About the Organization

Orlando Health is a trusted and respected healthcare organization with a legacy spanning over 100 years. We deliver professional and compassionate care through award-winning hospitals, ERs, specialty institutes, urgent care centers, primary care practices, and outpatient facilities across Florida. Our 27,000+ team members serve communities from the east to west coasts and beyond.

Forbes has named Orlando Health as one of America's Best-In-State Employers for 2024, and we have been recognized as one of the “Best Places to Work in Healthcare” by Modern Healthcare. Our positive culture ensures all team members feel respected, supported, and valued.

Benefits & Perks

• All-inclusive benefits starting on day one
• Student loan repayment and tuition reimbursement
• FREE college education programs
• Retirement savings plans
• Paid paternity leave
• Fertility benefits
• Backup elder and childcare
• Pet insurance
• Paid time off (PTO) and holidays (available for full-time and part-time employees)

About the Role

The Credentialing Specialist is responsible for the administration and coordination of all credentialing, reappointment/recredentialing, and delegated credentialing activities. This role ensures the needs of medical staff and managed care offices are met through efficient processes while maintaining compliance with accreditation standards, government agencies, and Orlando Health bylaws, rules, and regulations.

Responsibilities

Essential Functions

• Performs credentialing functions as outlined by Orlando Health management in accordance with established policy, procedures, and protocols.
• Performs timely and accurate primary source verification in addition to credentialing functions.
• Completes accurate and timely data entry of all credentialing activity into the credentialing database.
• Provides exceptional customer service to physicians, physician office staff, and internal customers (e.g., members of other departments).
• Educates physicians and physician office staff on the credentialing process and maintains ongoing contact throughout the process.
• Identifies trends and assists in developing action plans for performance improvement.
• Evaluates processes in departmental policies and procedures and makes recommendations for changes to management.
• Develops and distributes reports as necessary using the credentialing database.
• Ensures timely completion of all assigned duties.
• Maintains credentialing and reappointment/recredentialing files.
• Performs other duties as assigned.
• Maintains reasonably regular, punctual attendance consistent with Orlando Health policies, the ADA, FMLA, and other federal, state, and local standards.
• Maintains compliance with all Orlando Health policies and procedures.

Complexity of Work

• Requires critical thinking skills, decisive judgment, and the ability to work with minimal supervision.
• Must be able to work in a stressful environment and take appropriate action.
• Knowledge of medical credentialing and privileging procedures and standards.
• Knowledge of accreditation/government agency standards and Orlando Health bylaws, rules, and regulations.
• Assumes responsibility for professional growth and development.

Requirements

Education/Training

• High school graduate or equivalent.
• Knowledge of medical terminology.

Experience

• Three (3) years of credentialing/privileging experience, or
• One (1) year of credentialing/privileging experience and two (2) years of clinical experience.
• An associate degree in business, healthcare, accounting, or a related field may substitute for two (2) years of experience.
• A bachelor’s degree in health, business, or a related field may substitute for three (3) years of experience.

Skills

• Proficiency in Microsoft Word, Excel, and the Internet.
• Significant proficiency in credentialing data systems.