Credentialing Manager in Bradenton, Florida at Florida Digestive Health Specialists LLP

Location: Lakewood Ranch, Florida - Corporate Office

Florida Digestive Health Specialists, LLP, is seeking a full-time Credentialing Manager - to join our team.

Our Culture: Inspire hope. Build your legacy. Discover a rewarding, fulfilling, well-balanced career at Florida Digestive Health Specialist, LLP. With providers and locations across Florida, FDHS is one of the largest single-specialty, physician-owned GI practices in the state. FDHS was established in 2011 to provide comprehensive, high-quality gastroenterology services and foster advanced research for digestive health problems. With a growing team of nationally acclaimed care centers, providers, and staff, we continue to expand our reach to communities that need our care. As we continue to grow, we are seeking an APRN/PA to join our team and support our mission.

The Credentialing Manager is responsible for managing the complete credentialing, recredentialing, payer enrollment, and provider privileging processes for physicians and advanced practice providers.

This position ensures that all providers maintain active and accurate credentials, licenses, payer enrollments, hospital privileges, and regulatory documentation necessary to provide patient care and receive reimbursement. The Credentialing Manager works closely with providers, practice leadership, hospitals, health plans, government agencies, and internal departments to ensure timely completion of credentialing requirements and minimize delays in provider onboarding or reimbursement.

Essential Responsibilities:

Provider Credentialing & Recredentialing

• Manage initial credentialing and recredentialing for physicians, nurse practitioners, physician assistants, and other clinical providers.

• Prepare, submit, track, and maintain credentialing applications for hospitals, ambulatory surgery centers, health plans, and other healthcare organizations.

• Verify provider education, training, board certification, licenses, work history, malpractice coverage, references, and other required credentials.

• Maintain accurate provider credentialing files and ensure all documentation is current and readily accessible.

• Monitor credentialing applications from submission through approval and identify and resolve outstanding items.

• Communicate credentialing status, anticipated completion dates, and outstanding requirements to providers and leadership.

Payer Enrollment

• Manage enrollment and revalidation with Medicare, Medicaid, and commercial insurance plans.

• Maintain provider information in payer portals and systems.

• Complete and maintain CAQH profiles and ensure required documents and attestations remain current.

• Track effective dates, participation status, recredentialing deadlines, and payer-specific requirements.

• Coordinate with billing and revenue cycle teams to resolve enrollment-related issues affecting claims or reimbursement.

• Assist with provider additions, terminations, demographic changes, group affiliations, and tax ID/NPI updates.

Hospital & Facility Privileging

• Coordinate initial and renewal applications for hospital and facility privileges.

• Track privilege requirements, expirations, committee dates, and approval status.

• Maintain records of clinical privileges, affiliations, and facility-specific requirements.

• Coordinate with hospital medical staff offices and credentialing departments to obtain required documentation and resolve deficiencies.

Licensure & Compliance

• Monitor expiration dates for state medical licenses, DEA registrations, controlled-substance registrations, board certifications, malpractice insurance, BLS/ACLS certifications, and other applicable credentials.

• Maintain a comprehensive credentialing calendar and proactively initiate renewals.

• Ensure provider files comply with organizational, payer, hospital, and regulatory requirements.

• Identify potential credentialing or compliance issues and escalate them appropriately.

Provider Onboarding

• Establish credentialing timelines for new providers and coordinate requirements with Human Resources, Operations, Clinical Leadership, IT, Billing, and Revenue Cycle.

• Develop and maintain provider credentialing checklists.

• Ensure providers are appropriately enrolled and credentialed before their start dates whenever possible.

• Provide regular onboarding status updates to leadership and new providers.

Data Management & Reporting

• Maintain accurate provider rosters, credentialing databases, payer records, and electronic credentialing systems.

• Generate reports regarding upcoming expirations, pending applications, enrollment status, and credentialing compliance.

• Audit provider files periodically for completeness and accuracy.

• Maintain strict confidentiality of provider and organizational information.

Qualifications:

Required -

• 2+ years of healthcare credentialing, provider enrollment, medical staff services, or payer enrollment experience.

• Knowledge of physician and APP credentialing processes.

• Experience with CAQH, NPI, Medicare, Medicaid, and commercial payer enrollment.

• Strong organizational and time-management skills.

• Excellent attention to detail and ability to manage multiple deadlines simultaneously.

• Strong written and verbal communication skills.

• Proficiency with Microsoft Office, electronic databases, and web-based payer/credentialing portals.

Preferred -

• Experience working with a large multi-specialty or specialty medical practice.

• Experience with gastroenterology providers and/or ambulatory surgery centers.

• Experience with hospital medical staff credentialing and privileging.

• Familiarity with delegated credentialing and payer audits.

• Experience with credentialing software or provider enrollment platforms.

• CPCS, CPMSM, or other healthcare credentialing certification.

Physical Demands

The employee is frequently required to walk; sit; use hands for fine manipulation, handle or feel and reach with hands and arms using a keyboard and video display terminal. The employee is occasionally required to stand and stoop, kneel, crouch or crawl and climb stairs. The employee should be able to lift and move up to 25 lbs.

EEO Statement:

It is the policy of Florida Digestive Health Specialists to provide equal employment opportunities without regard to race, color, religion, sex, national origin, age, disability, marital status, veteran status, sexual orientation, genetic information or any other protected characteristic under applicable law.

­When you join FDHS, you become part of a premier team striving to deliver unparalleled, personalized care while treating patients like family. And at FDHS, our patients are at the heart of everything we do. Join our team at FDHS and make a difference in the lives of our patients and employees alike!