Amazing Opportunity! Live & work near Disney with Medinex Healthcare Solutions! (Remote/Hybrid work)
Job Summary
The Medical Insurance Credentialing Lead will play a foundational role in designing, launching, and leading the organization’s new credentialing and payer enrollment function. This individual will serve as the subject-matter expert for all credentialing operations, responsible for building workflows, managing payer enrollments, ensuring compliance, and developing a scalable service offering.
In addition to performing hands-on credentialing work, this role will establish processes, tools, and quality standards and will hire and oversee a Credentialing Assistant as volume grows. The ideal candidate has deep credentialing expertise, enjoys building programs from the ground up, and is comfortable operating in both strategic and hands-on capacities.
Key Responsibilities
Program & Service Line Development
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Design and implement the organization’s credentialing and re-credentialing program from the ground up
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Develop credentialing workflows, tracking tools, turnaround standards, and standard operating procedures (SOPs)
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Partner with leadership to support the launch of credentialing as a formal internal and external service offering
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Establish scalable processes to support future growth, new practices, and expanded service demand
Credentialing & Enrollment Operations
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Manage the full lifecycle of provider credentialing and re-credentialing for physicians and advanced practice providers
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Prepare, submit, track, and follow up on enrollment applications with Medicare, Medicaid, and commercial payers
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Maintain complete, accurate, and compliant provider credentialing files, including licenses, certifications, malpractice insurance, and payer documentation
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Ensure timely updates and attestations in CAQH ProView, PECOS, NPPES, and payer-specific portals
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Track credentialing timelines, expirations, and renewals to prevent billing delays or network participation gaps
Leadership & Oversight
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Serve as the primary credentialing resource and escalation point for internal teams and external physician partners
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Hire, train, and supervise a Credentialing Assistant as volume increases
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Perform quality checks and internal audits to ensure adherence to payer requirements, NCQA standards, and regulatory guidelines
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Create reporting and metrics related to credentialing turnaround times, payer approval rates, and revenue impact
Revenue Cycle & Compliance Collaboration
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Work closely with billing and RCM teams to ensure credentialing status aligns seamlessly with claims workflows
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Support new provider onboarding, practice start-ups, expansions, and network participation optimization
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Monitor payer policy changes and Florida-specific regulatory updates, recommending and implementing process improvements
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Contribute credentialing expertise to overall revenue optimization and compliance initiatives
Qualifications & Preferences
Required
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4+ years of progressive medical insurance credentialing experience
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Demonstrated success managing Medicare, Medicaid, and major commercial payer enrollments
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Strong working knowledge of CAQH ProView, PECOS, NPPES, and payer enrollment platforms
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Experience managing multiple providers and practices concurrently
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Exceptional organizational skills and attention to detail
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Strong written and verbal communication skills with payers, providers, and internal stakeholders
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Ability to work independently and take ownership of building new operational functions
Preferred
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Experience within an RCM, MSO, or multi-practice physician organization
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Prior experience launching or formalizing credentialing workflows or programs
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Bachelor’s degree in Healthcare Administration, Business, or related field
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CPCS or CPMSM certification strongly preferred
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Prior experience training or supervising credentialing staff
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Knowledge of Florida healthcare and payer regulations
What We Offer
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Competitive compensation with leadership and growth opportunity
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Comprehensive benefits package including medical, dental, vision, 401(k) with company match, and paid time off
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Flexible hybrid or remote work options
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Professional development support, including certification reimbursement
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Opportunity to build and lead a critical new service line from the ground up
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Collaborative culture focused on accountability, quality, and continuous improvement
Join Us
If you are a credentialing professional who thrives in building programs, improving processes, and supporting physician success, we invite you to apply and help us launch our credentialing service.
