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Credentialing Coordinator - Payor - Jacksonville, FL


Jacksonville, FL
ID: 5854-685

Position Summary: Responsible for the support and coordination of the credentialing of medical staff and health care providers for all markets within CareSpot | MedPost. This position will be responsible for ensuring that managed care providers receive requested information in a timely manner as well as maintaining positive relationships with the organizations. The Credentialing Payor Coordinator will also be responsible for ensuring that CareSpot | MedPost maintains proper licenses and certifications for all providers – Physicians, Nurse Practitioners, and Physician Assistants.  This position will also be responsible for preparing new centers with proper licensure.


Essential Responsibilities


Stays current on necessary documentation and other requirements needed by insurance companies for payor enrollment


Responsible for Provider and Facility enrollment


Assists with new center openings by ensuring that the center meets all state guidelines in regards to credentialing/payor enrollment.  Educates executive and management teams on the process, regulations, and standards set forth by the applicable organizations during the set-up of new centers.


Prepares center documentation for AHCA inspections as well as develop and maintain relationships with AHCA field offices


Updates provider, location, and facility demographics with various payors


Maintains and updates CAQH and NPPES


Manages PECOS Medicare enrollment, Medicaid enrollment, and other commercial payor enrollment


Performs other duties as assigned.


Acts with honesty and integrity in all business transactions, including, but not limited to, employment applications/resumes, patient records, time records, and financial transactions.





Minimum Qualifications:



  • High School diploma or equivalent; bachelor’s degree preferred
  • Knowledge of AHCA guidelines
  • Knowledge of MODIO credentialing software preferred



  • Minimum of 3 years of credentialing experience
  • Previous healthcare experience preferred
  • Experience with major payors enrollment BCBS, Cigna, Aetna, etc.


Additional Knowledge, Skills and Abilities:

  • Ability to streamline processes and maintain organized documentation
  • Ability to communication and work with all levels of employees including the executive team