Credentialing Specialist

Company: Cano Health
Location: Miami
Posted on: May 28, 2023

Job Description:

Overview:Cano Health fosters a culture driven by providing superior primary care services in the communities we serve, while forming lifelong bonds with our members. Guided by our mission to improve the health, wellness, and quality of life of our patients, Cano Health continues to work towards making a difference in primary healthcare. At Cano Health, our cultural attributes are to be patient centered, service focused, results oriented, trustworthy, transparent, and to continuously improve. Join our collaborative team, dedicated to the pursuit of excellence in health and wellness. Cano Health offers competitive salaries, medical, dental & vision insurance, employee mental health program, paid time off, paid holidays, 401(k) with employer match, employee stock purchase program, tuition reimbursement and much more. The Credentialing Specialist is responsible for all aspects of the privileging and credentialing process for all licensed clinician/providers of the center (i.e. physicians, physician assistants, ARNPs, dentist, dental hygienist, clinical counselors, etc.). In addition, this position is responsible for all communication leading toward insurance panel accreditation for staff and center. Responsibilities:Administrative/Accreditation Duties: Researches and processes new health plans applications for Center and its providers. Manages health plans enrollments, increasing plan acceptance/participation for Center and all providers using applicable software (i.e. OneApp Pro) Provides consistent, accurate, and timely credentialing support for Centers accreditation process. Acts as coordinator for furthering any and all Centers wide certifications it may decide to pursue. Acts as internal resource around issues associated with public funding sources, such as Medicaid and Medicare, as well as private payors. Ensures Center and its providers take advantage of all the existing incentive initiatives through Medicaid and Medicare with the submission of the appropriate application Provides accurate, timely and documented verification of the information provided by new applicants as well as current providers. Assists with the onboarding process of medical, dental and behavioral health services providers. Verifies, researches, and responds to telephone and written inquiries from providers and other departments, pertaining to provider participation and credentialing status. Works with medical and finance staff to ensure list of all current payers sorted by the number of patients within each group and all insurance carriers sorted by the type of product (Medicaid, Medicare, or CHIP), patient copay and fee schedule are kept and updated regularly. Regularly communicates to medical and finance staff on all health plans enrollments and updates. Coordinates all additions, terminations and changes to all plans as appropriate. Prepares and maintains reports on all accreditation and credentialing activities as required, Supports development (writing), implementation and upkeep of all Centers policies and procedures as needed. Assists to maintain Centers specialty care network.Quality Assurance/Credentialing Duties: In conjunction with Human Resources (HR) maintains compliance with documentation standards for verification of employee credentialing requirements, including but not limited to, licenses, certifications, registrations, permits, educational degrees, internship, residency and association memberships and any related electronic systems and software. In coordination with HR, ensures all required backgrounds and re-verifications are performed during hiring and thereafter. (i.e. National Practitioner Data Bank). In coordination with HR, ensures all records are properly kept for all providers (i.e. the National Practitioner Data Bank, CAQH, and the Utilization Review Accreditation Commission). Collects, enters and ensures data in the CAQH Universal Provider Data Source are updated. Participates in site visit(s) for credentialing purposes as well as programmatic audits as required. In conjunction with the Compliance Associate, ensures Centers credentialing process fully complies with HIPAA and Joint Commission. Ensures that on-line trainings are current as required (MyLearningPointe and other trainings).Safety: Participates in all safety programs which may include assignment to an emergency response team Acts upon assigned role in Emergency Code System Ensures proper hand washing according to Centers for Disease Control and Prevention guidelines.Qualifications: Minimum two years of experience managing credentialing, privileging, or similar healthcare professional verification and organizations accreditation processes are required. Minimum 1 year of experience in health plan enrollments and management is required Experience in insurance management is highly preferred. Credentialing Specialist (CPCS) preferred. Cano Health provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.

Keywords: Cano Health, Miami , Credentialing Specialist, Other , Miami, Florida