Credentialing and Contract Specialist in Remote, Florida at Florida Spine Associates

Join the Team at Florida Spine Associates!

Florida Spine Associates is a premier, multidisciplinary spine specialty private practice specializing in world-class orthopedic spine surgery, interventional pain management, and dedicated physical therapy. With regional clinics spanning South Florida—including Boca Raton, Boynton Beach, and Delray, West Palm Beach and Fort Lauderdale—our elite team of board-certified, fellowship-trained physicians is dedicated to restoring our patients' quality of life using cutting-edge, innovative technologies.

Unlike facility and corporate hospital networks, Florida Spine Associates operates on an agile, independent private practice model. We offer deeply personalized, compassionate patient care and clinical autonomy. Here, you are a highly valued member of a tight-knit medical team, working in a supportive space where your voice is heard, communication is seamless, and your contributions directly shape our standard of excellence. Experience dedicated growth, team collaboration, predictable work schedules, and an atmosphere that you are part of, heard and not lost in the large hospital environment.

Experienced Credentialing and Contract Specialist for a private medical practice manages provider enrollment with insurance networks and maintains regulatory compliance for all clinical staff.

Position Overview

• Role Type: Full-Time Remote
• Reports To: Practice Administrator
• Objective: Ensure all providers are actively credentialed, enrolled, and legally contracted with commercial and government payers to prevent any interruption in practice billing and revenue flow.

Key Responsibilities

Provider Credentialing & Re-Credentialing

• Complete and manage initial and ongoing credentialing and re-credentialing applications for physicians, nurse practitioners, and physician assistants.
• Perform primary source verification of provider education, training, board certification, work history, and professional licenses.
• Maintain and update provider profiles across key platforms such as CAQH, NPI Registry, and commercial payer portals (e.g., Availity).
• Track expiration dates for medical licenses, DEA registrations, malpractice insurance, and professional certifications, initiating renewals proactively.

Payer Contracting & Enrollment

• Negotiate, process, and track new group and individual provider contracts with commercial insurance carriers, Managed Care Organizations (MCOs), Medicare, and Medicaid.
• Maintain a comprehensive, up-to-date master insurance and fee schedule grid detailing the active in-network status of every provider.
• Coordinate demographic changes, practice address updates, and new provider additions or departures with all contracted insurance carriers.
• Audit explanation of benefits (EOBs) or payment rates to spot unexpected contract discrepancies and coordinate corrections with the billing department.

Compliance & Communication

• Serve as the direct liaison between the private practice, insurance credentialing departments, and hospital medical staff offices.
• Resolve rejected claims, enrollment backlogs, or network status discrepancies with insurance representatives.
• Ensure all files adhere strictly to state, federal, and accreditation standards (such as NCQA guidelines).

Qualifications & Skills

• Education: High school diploma required; Associate’s or Bachelor’s degree in Healthcare Administration or Business preferred.
• Experience: 3+ years of hands-on experience in medical provider credentialing, payer enrollment, or medical billing/reception within an outpatient or private practice setting.
• Certifications: Certified Provider Credentialing Specialist (CPCS) through NAMSS is a strong plus.
• Technical Skills: Familiarity with electronic medical record (EMR) systems, CAQH ProView, NPPES, and high proficiency in Microsoft Excel.
• Soft Skills: Exceptional organization, strict attention to detail, and proactive communication.

This position is open to Florida - Remote

Qualifications & Skills

• Education: High school diploma required; Associate’s or Bachelor’s degree in Healthcare Administration or Business preferred.
• Experience: 3+ years of hands-on experience in medical provider credentialing, payer enrollment, or medical billing/reception within an outpatient or private practice setting.
• Certifications: Certified Provider Credentialing Specialist (CPCS) through NAMSS is a strong plus.
• Technical Skills: Familiarity with electronic medical record (EMR) systems, CAQH ProView, NPPES, and high proficiency in Microsoft Excel.
• Soft Skills: Exceptional organization, strict attention to detail, and proactive communication.