Borland Groover is one of Florida’s leading gastroenterology providers. Founded in 1947, our mission is to provide exceptional care and improve the lives of our patients. We value ourselves on delivering quality care (quality), doing the right thing (accountability), caring for our patients (compassion), and taking care of our employees (collaboration). If you love the vision of Borland Groover and find your values aligning with ours, apply to join our team!
COMPANY DESCRIPTION
The Credentialing Specialist’s primary responsibility is to be the integral link between physicians and the enrollment in all-insurance companies, hospitals, professional memberships, organizations, and societies. As the “Central Hub” of communication for providers, the Credentialing Specialist is required to gather, decipher, and relay all information throughout the organization and its various departments.
ESSENTIAL JOB FUNCTIONS
Answer Provider Service phone calls and emails from managed care plans, hospitals, and other departments within the company as well as providers themselves.
The Specialists will answer and triage calls, try to resolve health plan questions or issues immediately or forward them to the Plan Representative, or enlist the assistance of other departments for resolution, as necessary.
Identify and resolve all issues that arise during enrollment for all provider types.
Prepare applications for initial enrollment in managed care plans, hospitals and professional organizations.
Responsible for the upkeep of the provider profiles on the Department of Health website.
Required to enroll all new Physicians with CAQH (Universal Credentialing Database) and IntelliCred (In-House Credentialing Database).
Process requests for re-credentialing from the managed care plans, hospitals and professional organizations for all provider types as requested.
Track all CME for providers and prepare quarterly reports for the providers to be updated on how many hours they have accumulated during the current renewal period.
Work closely with the Administrative team to receive updates on new providers joining the organization, group acquisitions, new or terminated managed care contracts, new service locations, physicians requiring enrollment at a new facility (i.e., surgery centers or hospitals), and notice of intent for any medical malpractice claims.
Required to keep documentation of all enrollments and reenrollments for three years.
Generally, support the managed care companies' provider representatives with the necessary information for initial credentialing purposes.
Required to perform monthly updates to the CAQH and Intellicred databases. This should include license, DEA, insurance, training, teaching appointments and all updates to medical malpractice claims.
Required to notify the in-house Insurance department, Scheduling department, Precert department, and administrative team with updates on provider participation as needed.
Update the status of enrollment spreadsheets for all providers to ensure that all departments are aware of and have access to this information.
Responsible for all Physician License and DEA renewals as needed.
Required to update Physician ID’s spreadsheet on the T-Drive as new provider identification numbers are issued.
Acquire letters from nominating Physicians for initial enrollment in all professional organizations and societies. The specialist will also be responsible for maintaining the Physician's active status in the organizations and societies by keeping their records current.
Responsible for maintaining and acquiring new CLIA Certificates or Certificates of Waiver. This will depend on which tests are performed in the office or facility.
Attend meetings as necessary to discuss the status of enrollment, mergers, and updates with the administrative team.
Follow all company policies and procedures, including dress code and attendance.
All other duties assigned. This list is intended to be used as a general outline of expected duties and responsibilities. It is not intended to be a comprehensive list and the requirements may change as the needs of the position and organization change.
Requires access to Personal Health Information (PHI), HIPAA training is required, and HIPAA compliance is expected.
Must follow the organization’s Code of Conduct
Must participate in the Compliance Program Initiatives and reporting and Compliance Issues
Other duties assigned
BENEFITS (FULL-TIME ONLY)
Health Insurance
Dental Insurance
Vision Insurance
401K Retirement Plan
Life Insurance
Short- and Long-term disability
Profit Sharing
Supplemental Insurance
Education and Tuition Reimbursement funding
Initial Uniform Allowance
Employee Assistance Program (EAP)
Paid Time Off (PTO)
Volunteer Time Off (VTO)
Paid Holidays
IMPORTANT NOTE
The above statements are intended to describe the general nature and level of work being performed. They are not intended to be an exhausted list of duties, responsibilities, and skills. Borland Groover is an equal opportunity employer, and all qualified applicants will receive consideration for employment 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. We thank all applicants for their interest, however only those selected for an interview will be contacted.
Seniority level
Entry level
Employment type
Full-time
Job function
Health Care Provider
Industries
Hospitals and Health Care
Referrals increase your chances of interviewing at Borland Groover by 2x