Healthcare Credentialing Specialist Job at Pinnaclewoundmanagement, Doral, FL

ckMwKzB4SjFjZHl0c2JqNlMrMEdtYms9
  • Pinnaclewoundmanagement
  • Doral, FL

Job Description

Miami, United States | Posted on 10/20/2025

Pinnacle Wound Management is a leading wound care provider dedicated to delivering high-quality patient care. We are seeking a detail-oriented Healthcare Credentialing Specialist to join our team. This role is critical in ensuring our healthcare professionals meet all necessary licensing, certification, and regulatory requirements.

As a Healthcare Credentialing Specialist , you will be responsible for managing the credentialing and re-credentialing process for all of our physicians and mid-level healthcare providers. You will maintain accurate records, verify professional credentials, and ensure compliance with industry regulations and accreditation standards.

If you are a meticulous and organized professional with a passion for healthcare compliance, we want to hear from you! Apply now to join us in ensuring the highest standards of wound care excellence!

Key Responsibilities:

  • Maintain accurate and up-to-date provider files, ensuring compliance with all credentialing requirements
  • Complete and track initial and re-credentialing applications for various health insurance portals, including CAQH, PECOS, NPPES, Navinet, Availity, PaySpan, CMS, and Managed Care Organizations
  • Assist new providers with applications for National Provider Identifier (NPI), Medicare, and Medicaid numbers. Monitor and update provider CAQH profiles in accordance with CMS and Managed Care Organization guidelines
  • Manage termination of payer enrollments for providers leaving the organization
  • Provide updated demographic information and supporting documents to external stakeholders, including commercial payers and billing entities
  • Collaborate with the Director of Operations to ensure timely credentialing and re-credentialing of all providers.
  • Track and ensure the renewal of state DEA licenses, board certifications, and malpractice insurance
  • Identify and resolve potential onboarding issues, offering solutions to streamline the credentialing process
  • Maintain records of all managed care contracts and ensure portal logins remain active. Ensure compliance with relevant accrediting and regulatory agencies
  • Monitor trends and recommend improvements to credentialing workflows
Requirements
  • High school diploma or equivalent; credentialing certificate preferred
  • Minimum of 5 years experience in physician credentialing, revenue cycle management, or related field
  • Knowledge of credentialing standards and healthcare regulations
  • Proficiency in credentialing software and Microsoft Office Suite
  • Strong attention to detail, organizational, and problem-solving skills
  • Excellent written and verbal communication skills
  • Ability to work independently and manage multiple tasks efficiently

#J-18808-Ljbffr

Job Tags

Work at office,

Similar Jobs

Butler Machinery Company

Work Study ND - High School Program Job at Butler Machinery Company

 ...Job Description Job Description Program Objective: An internship in a Butler Service Shop to set you up for a career as a...  ...technician. The objective of our work-study internship is for high school students to get a hands-on education learning about the heavy... 

CoxHealth

CDI Educator Job at CoxHealth

Description :Job Summary The Clinical Documentation Integrity Educator will be responsible for working closely with the CDI Manager, CDI Supervisor, CDI Team Lead, CDI Specialists, Medical Director-Coding/CDI, Inpatient Coding Supervisor and Team Leaders of Coding...

Binding Minds

Travel Nurse RN - Med Surg / Telemetry Job at Binding Minds

 ...Job Description Binding Minds is seeking a travel nurse RN Med Surg / Telemetry for a travel nursing job in Bowling Green, Kentucky...  ...process/model that covers all healthcare (Nursing, Healthcare Techs, Allied, Finance & Billing) and Healthcare IT roles. We... 

Integr8staff

Billing/ Accounts Receivable Clerk Job at Integr8staff

 ...Job Title - Billing/ Accounts Receivable Clerk Full Time, Temporary with possibility of perm hire 100% onsite in Carson, CA $25.00/hr Schedule - M-F; 8am to 5pm Responsibilities of the Billing/ Accounts Receivable Clerk Handle all customer billing and collections... 

Cali Cafe

Nanny / Mother's Helper / Assistant Needed: Caring, Organized, Warm Job at Cali Cafe

 ...30/7 PM; occasional Saturday or Sunday mornings/afternoons (approx. 1420 hrs/week) Compensation: $19$22/hr DOE (Regular rate paid for any federal holidays worked) We are a warm and active family seeking a reliable, caring, and experienced nanny/mothers helper...