Do you want to make a difference in the community?
Are you looking to add to your career in healthcare?
Evara Health has been serving the community for over 40 years. We are a not-for-profit health care organization with 14 locations throughout Pinellas County, FL!
The Credentialing & Enrollment Specialist is responsible for supporting the credentialing and enrollment needs of healthcare providers at Evara Health. Specialists in this role may focus primarily on employment credentialing or payer enrollment, ensuring that providers meet the required qualifications, compliance standards, and regulatory guidelines for their respective functions. Whether handling provider credentialing for employment or facilitating payer enrollment, this position is essential to maintaining compliance, supporting patient access, and contributing to seamless operational workflows. The Credentialing Specialist will work closely with providers, external payers, and internal teams, maintaining high standards of accuracy, confidentiality, and efficiency.
ESSENTIAL DUTIES & RESPONSIBILITIES :
Provider Credentialing & Re-Credentialing
- Manage the full credentialing, enrollment, and re-enrollment processes for healthcare providers, including employment and payer enrollment with Medicare, Medicaid, managed care, and other commercial insurance networks.
- Gather, review, and verify required documentation, including licensure, board certifications, DEA registration, malpractice insurance, and educational background, adhering to payer and organizational standards.
- Submit accurate applications and follow up on status with third-party payers, state licensing boards, and relevant agencies to ensure timely credentialing.
Documentation & Compliance
Maintain accurate provider records within credentialing databases, including credentialing and re-credentialing activities, expirable, and ongoing compliance documentation.Track expiration dates for licenses, certifications, and insurance, ensuring uninterrupted provider participation in network contracts and federal programs.Conduct primary source verification and background checks to comply with NCQA, AAAHC, HRSA, FTCA and other regulatory standards.Database & Systems
Use credentialing and enrollment software to organize workflows, track deadlines, and generate reports on provider enrollment and re-credentialing status.Ensure provider data remains current in payer databases and internal systems, preventing enrollment status lapses and interruptions in reimbursement.Payer Communication & Issue Resolution
Serve as the primary contact for credentialing and payer enrollment inquiries, working closely with providers, billing, and revenue cycle teams to communicate statuses and resolve issues.Maintain relationships with payer representatives to expedite enrollment processes and ensure ongoing compliance.Address requests for additional documentation or information from payers, acting as a liaison between providers and payer contacts as necessary.Process Improvement
Identify and recommend improvements to streamline credentialing and enrollment processes, reduce turnaround times, and increase efficiency.Develop and implement credentialing checklists, templates, and tracking tools for consistent, effective workflows and a clear audit trail for all credentialing actions.These essential job functions are not to be construed as a complete statement of all duties assigned. Employees will be required to perform other job-related duties as required.
CORE COMPETENCIES :
Attention to Detail : Diligently executes tasks with precision, carefully checking work to prevent errors. Applies this competency in daily operations, ensuring data entry, patient records, or procedural steps are thoroughly and accurately completed.Communicates Effectively : Communicates with clarity and precision, selecting appropriate methods (emails, meetings, instant messages) based on the content and urgency of the message. Practices active listening in daily interactions, demonstrating empathy and understanding, which aids in effective collaboration and conflict resolution.Accountability : Demonstrates personal accountability by reliably completing assigned tasks and openly communicating about work progress. Takes responsibility for personal actions and their direct impact on projects.Compliance Focused : Diligently follows established procedures and protocols, understanding their role in maintaining compliance. Regularly participates in training and updates related to regulatory requirements. Reports discrepancies and concerns to ensure immediate rectification and adherence to standards.EDUCATION AND EXPERIENCE :
High School Diploma or GED required; Associate's or Bachelor's degree in Healthcare Administration or related field preferred.Minimum of 2 years of experience in provider credentialing or payer enrollment preferably in an FQHC, hospital or multi-specialty practice setting. Familiarity with Medicare / Medicaid enrollment is strongly preferred.CULTURE
Evara Health strives to not only be the healthcare provider of choice, but also the employer of choice, one that offers you the opportunity to excel in your career and be a difference maker in the lives of the patients we serve.
BENEFITS
Up to 18 days of PTO in your first year10 paid holidaysPre-Taxed flexible insurance package403B with company contributionsTuition reimbursementPaid TrainingApply now and be part of our passionate team dedicated to patient-centered excellence at Evara Health.
Your journey to making a difference starts here!
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