Credentialing and Licensing Specialist

Job not on LinkedIn

🔥 6 minutes ago

🐊 Florida – Remote

🐊 Florida – Remote

💵 $24 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 0%

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Coloplast

WebsiteLinkedInAll Job Openings

10,000+ employees

🏭 Manufacturing

🏥 Healthcare

Manufacturing • Healthcare • Medical Devices

Coloplast is one of the most successful medical device companies in the world, dedicated to improving the lives of individuals with intimate healthcare needs. Founded in 1957, the company was inspired by a nurse's desire to help and an engineer's commitment to innovation. With a strong emphasis on collaboration, inclusion, and personal empowerment, Coloplast creates solutions that enhance the quality of life for millions globally. Their mission reflects a deep commitment to caring for individuals, making everyday life easier for those they serve.

📋 Description

• Oversee initial and ongoing payer enrollment, credentialing, recredentialing, revalidation, and regulatory reporting activities • Ensure compliance with federal, state, contractual, and payer-specific requirements • Obtain, renew, and maintain business and operational licenses and registrations, including Board of Pharmacy, HME/DMEPOS, facility, business, and Secretary of State filings • Manage payer information within patient management and billing systems • Process payer enrollment, revalidation, credentialing, and re-credentialing applications for Medicare, Medicaid, managed care organizations, commercial health plans, and other contracted payers • Monitor application status and perform follow-up to ensure timely participation and reimbursement • Manage payer portals, demographic maintenance, ownership updates, licensure updates, revalidations, and enrollment records • Manage company licenses, state DME permits, supplier registrations, business licenses, and accreditation requirements • Maintain Medicare supplier enrollment records and PECOS-related documentation • Prepare and submit ownership disclosures, corporate structure updates, adverse action disclosures, and other regulatory filings • Set up and maintain EDI enrollments, electronic claims submission processes, clearinghouse relationships, payer IDs, and payer connectivity • Process EFT and ERA applications • Maintain contract-related reference sheets, job aids, tracking sheets, and reference guides • Distribute internal communications regarding new payer contracts or policy changes • Maintain reimbursement fee schedules and payer-specific pricing information • Communicate contracted payer participation status to internal and external stakeholders • Assist the Market Access Team with commercial contract and health plan applications or credentialing initiatives • Maintain compliance with Medicare supplier standards, accreditation requirements, regulations, payer requirements, and company policies • Conduct business according to applicable laws, ethical standards, and company policies • Perform other duties as assigned

🎯 Requirements

• High school diploma or equivalent required • 3-5 years of experience in healthcare administration, payer enrollment, credentialing, licensing, provider relations, or related support functions • Strong organizational skills with the ability to manage multiple priorities and meet deadlines • Proficiency in Microsoft Office Suite and other business-related software applications • Strong attention to detail and data entry accuracy • Ability to interpret instructions, policies, and payer requirements and complete tasks independently • Excellent verbal and written communication skills • Ability to adapt to changing priorities and work effectively in a fast-paced environment • Strong time management, problem-solving, and decision-making skills • Ability to work both independently and as part of a team • Experience with Medicare, Medicaid, commercial payers, or healthcare network operations preferred • Knowledge of payer enrollment, credentialing, contracting, licensing, or regulatory compliance processes preferred • Experience with payer portals, EFT/ERA enrollment, or provider/supplier data management preferred • Familiarity with HIPAA and healthcare privacy requirements preferred • Experience in the Durable Medical Equipment (DME) industry preferred

🏖️ Benefits

• Comprehensive medical, dental, and vision insurance plans • Company-sponsored wellness programs • Mental health resources • Paid leave of absence for qualifying events • Generous paid parental leave for birthing and non-birthing parents • Competitive 401(k) plan with immediate company match vesting • Financial planning services • Corporate discount programs • Generous paid time off • Flexible work hours • Flexible work arrangement options may be available • Training programs • Mentorship • Tuition reimbursement • Recognition programs, including peer recognition • Bonuses • Awards and special events • Team-building activities • Volunteer opportunities • Company-sponsored events