Job description

About us

Simetria Health is a healthcare operations, technology, and revenue cycle consulting company focused on minimizing the burden of administrative work for our clients.  Our clients consist of physicians looking to start their own practice, large ambulatory care groups, stand-alone emergency rooms, and hospitals.  We engage with our clients to optimize some of the most complex and difficult operational, clinical, and administrative workflows required to run their businesses.  We think ahead and remove barriers for our clients so they can focus on providing the best care for their patients.

Position Summary:

The Credentialing Specialist is responsible for maintaining active status for all providers by successfully completing initial and subsequent credentialing packages as required by all payors including commercial, Medicare, and Medicaid.

Essential Functions:

• Acts as a liaison between medical staff, administration and healthcare plans; meet with providers to collect and review credentialing data
• Maintain individual provider files to include up to date information needed to complete the required governmental and commercial payor credentialing applications
• Maintain internal provider grid to ensure all information is accurate and logins are available
• Update each provider’s CAQH database file timely according to the schedule published
• Obtain all provider licenses that are renewed; Professional, DEA, Controlled Substance (MCSR)
• Complete revalidation requests issued by government payors
• Complete credentialing applications to add providers to commercial payors, Medicare, and Medicaid
• Complete re-credentialing applications for commercial payors
• Credential new providers and re-credential current providers
• Work closely with the Revenue Cycle Director and billing staff to identify and resolve any denials or authorization issues related to provider credentialing
• Maintain accurate provider profiles on CAQH, PECOS, NPPES, and CMS databases
• Set up and maintain provider information in an online credentialing database system
• Other duties as assigned
• Maintain data for all providers and track the expiration of certifications and licenses, ensuring the providers update their certification and/or licensure timely
• Ensure that all credentialing files are completed accurately and timely for Board review/approval
• Maintain professional relationships with all payors to ensure credentialing is completed in a timely manner.

Knowledge and Experience:

• Detail oriented, an organized decision maker with the ability to work both independently and in teams
• Strong communication skills, both written and oral
• Proficient in the use of the Microsoft Suite of products such as Word, Excel, and Outlook
• Excellent customer service skills; communicates clearly and effectively

Education, Certification Training and License:

• 2 years of Medical Credentialing Experience is required
• 2 years experience in a medical practice business office role or medical billing is required
• High school diploma, or equivalent
• Preferred bachelor's degree in a Healthcare, Quality Assurance, or related field.

Job Type: Full-time

Pay: $40,000.00 - $60,000.00 per year

Benefits:

• 401(k)
• 401(k) matching
• Flexible schedule
• Health insurance
• Paid time off
• Parental leave

Schedule:

• 8 hour shift
• Day shift
• Monday to Friday

Ability to commute/relocate:

• Tampa, FL: Reliably commute or planning to relocate before starting work (Preferred)

Experience:

• Microsoft Excel (Required)
• Microsoft Office (Required)

Work Location: In person

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