Credentialing & Patient Accounts Specialist

Credentialing & Patient Accounts Specialist Full-time Work Shift: Variable Shift La Rabida Children’s Hospital is a not-for-profit hospital licensed for 49 beds. We provide specialized, family-centered health care to children with medically complex conditions, disabilities, and chronic illness. We support families and patients with a range of services including rehabilitation, specialty care, forensic and treatment services, and early intervention. Our primary goal is to ensure children reach their fullest potential while maintaining regulatory compliance. Summary A Credentialing and Patient Accounts Specialist verifies healthcare provider credentials, manages enrollment with payers, tracks license and certification expirations, and supports patient account activities to ensure compliance and smooth billing operations. The role oversees patient account processes related to provider enrollment, insurance verification, and coordination with billing teams to prevent claim delays. Essential Functions Collect, verify, and maintain provider credentials, licenses, certifications, and other required documentation Perform primary source verification for education, medical training, licensure, DEA registrations, and malpractice coverage Submit initial and recredentialing applications to insurance payers including Medicare, Medicaid, and commercial plans Monitor expiration dates for licenses, certifications, and insurance, initiating renewals as needed Maintain organized, audit-ready credentialing files and prepare reports for committees or leadership Patient Accounts Support Communicate provider enrollment status with revenue cycle management, billing teams, and leadership to avoid claim delays Troubleshoot enrollment rejections, data mismatches, or payer requests to ensure timely processing Maintain accurate records of provider participation and insurance plan affiliations in credentialing databases Compliance & Regulatory Duties Ensure all credentialing and patient account processes comply with NCQA, The Joint Commission, CMS, and state regulatory standards Stay current with federal and state regulations related to provider credentials and insurance Participate in audits and provide data or documentation as required Develop and enhance internal credentialing and patient account processes Communication & Coordination Coordinate between internal departments, providers, and external agencies to collect necessary information and resolve issues Respond to inquiries from providers or payers regarding credentialing and enrollment processes Provide guidance or training to other staff on credentialing workflows, software use, and documentation standards Education Associate’s or Bachelor’s degree in Healthcare Administration, Business, or a related field preferred; comparable experience may be considered. Related Work Experience 2-3 years in credentialing, provider enrollment, or healthcare administrative support; experience with patient accounts or billing is a plus. Licensure/Certification CPCS (Certified Provider Credentialing Specialist) preferred; CPMSM preferred. Specialized Knowledge and Skills Proficiency with credentialing software and databases (e.g., CAQH, PECOS, NPPES, VerityStream, Cactus, IntelliSoft) Familiarity with Microsoft Office, particularly Excel and Word Strong organizational and time-management abilities Effective communication skills to liaise with providers, payers, and internal teams; ability to manage confidential information and multitask under pressure La Rabida Children’s Hospital is very proud to be an Equal Employment Opportunity Employer. #J-18808-Ljbffr La Rabida