- Professional
- Bureau à Miami
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 a critical role in ensuring that all healthcare providers within the organization meet the necessary professional and regulatory standards to deliver safe and effective care. This position is responsible for managing the credentialing process from application through verification, re-credentialing, and ongoing monitoring, ensuring compliance with internal policies and external regulatory requirements. The 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, this role supports the organization's commitment to quality member care and risk management. Ultimately, the Coordinator, Credentialing ensures that all practitioners are properly qualified and authorized to provide healthcare 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.
- At least 2 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 the 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:
- Manage the end-to-end credentialing and re-credentialing process for healthcare 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 internal departments such as Human Resources, Compliance, and Quality Assurance to support credentialing-related initiatives and resolve any discrepancies or issues.
