Credentialing and Licensing Specialist

Job not on LinkedIn

🔥 2 hours ago

🐊 Florida – Remote

🐊 Florida – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 11%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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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 in 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 follow up to ensure timely participation and reimbursement. • Administer payer accounts, portals, demographics, 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 updates, adverse action disclosures, and regulatory filings. • Set up and maintain EDI enrollments, electronic claims submission, clearinghouse relationships, payer IDs, and payer connectivity. • Process EFT and ERA applications. • Maintain contract reference materials and distribute internal communications regarding payer contracts and policy changes. • Maintain reimbursement fee schedules and payer-specific pricing information; process updates to reimbursement methodologies. • Communicate contracted payer participation status to internal and external stakeholders. • Assist the Market Access Team with commercial contract and health plan applications and credentialing initiatives. • Maintain compliance with Medicare supplier standards, accreditation requirements, regulations, payer requirements, and company policies. • Perform other duties as assigned.

🎯 Requirements

• High school diploma or equivalent required; Associate degree preferred. • 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.