Credentialing Coordinator in Jacksonville, Florida at ANGEL KIDS PEDIATRICS, P A

Job Title: Credentialing and Payer Enrollment Coordinator
Reports to: Chief Quality & Compliance Officer

Summary
As the largest pediatric clinic in Jacksonville, serving 10 locations and nearly 45,000 patients, Angel Kids Pediatrics believes that caring for children is a continuous process and should not be limited to doctor’s office visits during regular business hours.
We believe that by providing excellent medical care in a family- and community-based environment, we can help raise healthy children who grow into healthy adults. We uphold the highest standards of a patient-centered medical home by delivering quality, personalized, and effective medical care as if each family were part of our own.
Equity, innovation, and inclusion guide our growth and strategy. We are seeking individuals who are passionate about providing culturally relevant care, reducing health disparities, and helping build a diverse and inclusive team environment.
Position Summary:

The Credentialing and Payer Enrollment Coordinator owns the day-to-day process that allows Angel Kids providers and locations to participate with payers and see patients without avoidable enrollment delays. This person coordinates initial credentialing, payer enrollment, recredentialing, revalidation, and changes for pediatric and behavioral health providers across our practice. The role follows each case through written confirmation of participation and a usable handoff to scheduling and revenue cycle. It also gives the leadership team clear visibility into aging applications, upcoming expirations, payer barriers, and risks to patient access or reimbursement.

Essential Duties and Responsibilities:

• Manage provider onboarding and ongoing maintenance for physicians, advanced practice providers, behavioral health clinicians, groups, and practice locations as applicable. Collect complete applications and supporting documents, submit to Medicaid, Medicare, commercial payers, and delegated entities where relevant, and maintain a documented follow-up cadence until resolved.
• Maintain accurate CAQH profiles and attestations, NPPES information, payer portals, provider rosters, and internal records. Track licenses, DEA registrations when applicable, board status, professional liability coverage, tax and group information, and other payer-required documents and expiration dates.
• Complete and document primary source verification and screening required by applicable payer contracts, credentialing standards, and organizational policy. Escalate adverse findings or discrepancies to the designated clinical and compliance leaders; do not make independent determinations about provider eligibility or clinical privileges.
• Verify separately each milestone: credentialing approval, network or group affiliation, payer enrollment, effective date, approved location and specialty, provider and group identifiers, and billing readiness. Obtain written confirmation when possible and resolve conflicting payer records before closing an item.
• Coordinate recredentialing, revalidation, renewals, additions, terminations, leave of absence, changes in specialty, demographic changes, and new location or tax ID updates. Submit notices within payer deadlines and verify that downstream directories and participation records reflect the change.
• Maintain a centralized tracker and organized source documents showing owner, submission date, payer reference, status, last contact, next action, deadline, and confirmed effective date. Provide a concise recurring status report that identifies aging cases and proposed escalations.
• Partner with recruiting, practice operations, clinical leaders, scheduling, billing, and revenue cycle on start dates and payer readiness. Communicate participation limitations so a provider or site is not represented as in network before it is confirmed. Help investigate enrollment-related denials and payer setup errors through correction and validation.
• Support network participation and payer contracting work by gathering provider or site data, tracking applications and agreements, reviewing roster and fee schedule implementation for discrepancies, and routing contract decisions, negotiation, legal review, and signature to authorized leaders.
• Prepare documentation for applicable payer or delegated credentialing audits and support corrective actions. Maintain confidentiality and secure handling of provider and patient information under organizational policies and applicable privacy requirements.
• Any other responsibilities and/or tasks designated by supervisor.

Required Qualifications:

• Associate’s degree required.
• Two years’ experience in a medical office, healthcare coordination, medical records, or patient services role.
• Knowledge of medical terminology and healthcare workflows.
• Experience with electronic health records (EHR) systems preferred.
• Strong communication, organization, follow-through and documentation skills.
• Ability to manage confidential patient information in accordance with HIPAA requirements.
• Ability to work accurately, prioritize tasks, and solve problems in a fast-paced environment.
• Must demonstrate alignment with the Angel Kids Pediatrics’ mission, culture, and commitment to taking care of people.
• Working knowledge of CAQH, NPPES, Medicaid and Medicare enrollment tools as relevant to assigned providers, commercial payer portals, primary source verification, and recredentialing requirements. Ability to distinguish credentialing approval from contracting, enrollment, and claim payment readiness.
• Strong spreadsheet and recordkeeping skills; demonstrated ability to manage concurrent deadlines, interpret payer instructions, obtain clear written answers, and communicate next steps to both operational and revenue cycle teams.
• Sound judgment with confidential information, careful attention to accuracy, independent follow-through, and willingness to escalate barriers early with a recommended action.

Preferred Qualifications:

• Bachelor's degree preferred.
• Experience with Florida Medicaid plans, delegated credentialing, provider data audits, and enrollment-related denials; CPCS or comparable credentialing certification; associate degree or higher in healthcare administration or a related field.
• Experience communicating with hospitals, specialists, and healthcare organizations.
• Pediatric healthcare experience preferred.
• Familiarity with quality measures and contracting
• Experience in site audits and corrective action plans

Measures of success
• Success is measured by complete and timely submissions, documented payer follow-up, renewals and revalidations completed before deadlines, accurate provider and location records, early escalation of stalled cases, and a verified handoff to scheduling and billing. Payer processing time is tracked separately from work within the specialist’s control.

Role scope
• This is an individual contributor position with ownership of credentialing and enrollment coordination. Clinical eligibility decisions, contract negotiation and signature, and legal interpretations remain with designated leaders. Other related duties may be assigned as the practice’s needs evolve.

Physical Requirements:

• Sitting and working on a computer for 8+ hours per day.
• Frequent communication with patients, referral partners, payers, and internal teams.
• May participate in an on-call schedule as required.
• Must be able to occasionally lift up to 15 pounds.

Position Classification:
Non-Clinical / Administrative Role
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Equal Employment Opportunity
Angel Kids Pediatrics is an equal opportunity employer. We provide equal employment opportunities to all employees and applicants and prohibit discrimination, harassment, or retaliation based on race, color, religion, sex—including pregnancy, sexual orientation, and gender identity—national origin, ancestry, age, disability, genetic information, marital status, military or veteran status, or any other status protected by applicable federal, state, or local law.
Angel Kids Pediatrics is committed to ensuring equal employment opportunities in employment, recruitment, selection, compensation, benefits, promotion, demotion, layoff, termination, and all other terms and conditions of employment.
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Position Type / Expected Hours of Work
This is a full-time position.
8-hour shift within the workdays and hours below:
• Monday – Friday: 6:00 a.m. – 5:00 p.m.
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