We are seeking a Credentialing Coordinator to join our team at Independent Living Systems (ILS). ILS, along with its affiliated health plans known as Florida Community Care and Florida Complete Care, is committed to promoting a higher quality of life and maximizing independence for all vulnerable populations.
About the Role:
The Credentialing Coordinator plays an essential role in ensuring that all provider partners within the organization's contracted networks meet the necessary professional and regulatory standards to deliver safe and effective care. The Credentialing Coordinator is responsible for handling the credentialing process from application through verification, re-credentialing, and ongoing monitoring, ensuring compliance with internal policies and external regulatory requirements. The Credentialing Coordinator collaborates closely with healthcare providers, administrative teams, and regulatory bodies to maintain accurate and up-to-date credentialing records. By maintaining rigorous credentialing standards, the Credentialing Coordinator supports the organization's commitment to quality member care and risk management. Ultimately, the Credentialing Coordinator ensures that all contracted providers are properly qualified and authorized to provide health and social care services, thereby safeguarding the organization's reputation and operational integrity.
Minimum Qualifications:
Associate's degree or equivalent experience in healthcare administration, business, or a related field.
1 years of experience in credentialing or a related administrative role within a healthcare setting.
Strong knowledge of healthcare credentialing standards, regulatory requirements, and accreditation processes.
Proficiency with credentialing software and Microsoft Office Suite.
Relevant experience may substitute for educational requirement on a year-for-year basis.
Preferred Qualifications:
Bachelor's degree in healthcare administration, business, or a related discipline.
Certification in credentialing such as Certified Provider Credentialing Specialist (CPCS) or equivalent.
Experience working with electronic health records (EHR) systems and healthcare compliance software.
Familiarity with state and federal healthcare regulations including NCQA, URAC, and The Joint Commission standards.
Responsibilities:
Administer the end-to-end credentialing and re-credentialing process for contracted providers, including collecting, verifying, and maintaining documentation of qualifications, licenses, certifications, and work history.
Coordinate with providers, licensing boards, and third-party verification services to ensure timely and accurate credentialing information.
Maintain and update credentialing databases and records to ensure compliance with organizational policies and regulatory standards.
Prepare and submit credentialing reports and documentation for internal audits and external regulatory reviews.
Collaborate with various departments and internal teams to support credentialing-related initiatives and resolve any discrepancies or issues.