Credentialing Specialist - Facilities

Baptist Health Care
United States, Florida, Pensacola
Jan 10, 2025
Job Description The Credentialing Specialist is responsible for preparing and submitting credentialing applications and supporting documentation for the purpose of enrolling facilities with appropriate governmental payers. These enrollments include completely new submissions and recredentialing when necessary. Responsibilities Credentialing and privileging of all new facility locations for multiple hospitals and participating insurances. Responsible for receiving, reviewing and entering provider data into credentialing database. Accurately complete the enrollment/re-enrollment processes within Medicare PECOS for all facilities Maintain all Facility NPI's through NPPES website Maintain all Medicaid enrollments (Florida and Out-of-State) Maintain all Provider accounts within Availity Provider Data Management Maintains credentialing and excel database programs for Credentialing Department. Coordinates incoming mail and filing systems. Responds to and resolves problems with provider network participation as it relates to denial of services or reimbursement by working closely with the Central Billing Office and all levels of administrative personnel Assists with new user enrollment through payer eligibility sites and DDE enrollment forms Prepares ad hoc and special reports as needed or requested. Qualifications 1-3 years of relevant revenue cycle experience Experience coordinating and/or processing physician or facility payer enrollment preferred High School Diploma or Equivalent About Us Baptist Health Care is a not-for-profit health care system committed to improving the quality of life for people and communities in northwest Florida and south Alabama. The organization includes three hospitals, four medical parks, Andrews Institute for Orthopaedic & Sports Medicine, and an extensive primary and specialty care provider network. With more than 4,000 team members, Baptist Health Care is one of the largest non-governmental employers in northwest Florida. Baptist Health Care, Inc. is an Equal Opportunity Employer. BHC maintains and enforces a policy that prohibits discrimination against any workforce members or applicants for employment because of sex, race, age, color, disability, marital status, national origin, religion, genetic information, or other category protected by federal, state or local law.