Credentialing Specialist

1 month ago

Metairie, United States LCMC Health Full time

Your job is more than a job.

The Credentialing Specialist is responsible for all aspects of credentialing and re-credentialing of assigned medical staff group employed or contracted through the organization. Supports departmental activities to ensure quality in conducting, maintaining, and communicating clinical staff credentialing, privileging and primary source verification. Monitors all statuses of the credentialing process for the employed medical providers and mid-level providers at LCMC Health. Responsible for ensuring providers are credentialed with all contracted health plans. Serves as a resource to the clinical staff regarding bylaws, rules and regulations, medical staff departmental issues and committee functions.

Your every day

  • Medical Staff Credentialing/Privileging:Assists with duties to include but not limited to credentialing/privileging process, gathering data, primary source verification, etc., at staff's initial appointment and reappointment. Assists with management of medical staff committees as and when required and/or directed.
  • Technical:Manages the credentialing and re-credentialing process as well as assist providers with accurate completion of enrollment process to ensure deadlines are met. Ensures timely credentialing is done for new providers with each payer and notify physicians, scheduling and billing offices of incomplete credentialing and expected approval date to ensure clean billing. Maintains accurate and updated provider information in applicable systems. Assists in credentialing renewal process on a timely basis for existing medical staff and initiates credentialing process for new staff as necessary.
  • Analytics: Keeps management updated on status of payer enrollment and/or any matters requiring attention via scheduled documented reporting. Generates and monitors monthly/periodic provider report to determine outstanding claims, payer enrollment status, status of providers and other credentialing data.
  • Collaboration: Collaborates with medical staff office as well as cross-functional team members to record updates to ensure credentialing process is smooth and claims are processes correctly. Ensures smooth functioning of the physician practice plan to ensure updates are received when/if credentialing is delayed.
This job description is intended to describe the general nature and level of work performed by employees assigned to this department. This is not an exhaustive list of all duties and responsibilities, and LCMC Health reserves the right to amend and change responsibilities to meet organizational needs as necessary.

Your must haves
  • Required: High School Diploma/GED or equivalent OR 2 years of experience in administrative support, insurance enrollment, payer credentialing, billing, or like field.
  • Input data accurately into appropriate system and maintain records/database to ensure up-to-date information.
  • Excellent organizational skills, oral and written skills.
  • Ability to follow-up on pending items and critical thinking. Ability to act independently and ability to maintain confidentiality.
  • Competency in Microsoft Office, specifically Excel, Outlook, PowerPoint and Word.
  • Ability to take and transcribe minutes.
WORK SHIFT:

Days (United States of America)
LCMC Health is a community.

Our people make health happen. While our NOLA roots run deep, our branches are the vessels that carry our mission of bringing the best possible care to every person and parish in Louisiana and beyond and put a little more heart and soul into healthcare along the way. Celebrating authenticity, originality, equity, inclusion and a little "come on in" attitude is the foundation of LCMC Health's culture of everyday extraordinary

About East Jefferson General Hospital

East Jefferson General Hospital, a landmark of LCMC Health's incredible community of care, has been the go-to hospital for health, wellness, and one-of-a-kind care in East Jefferson Parish for over 50 years. And we're only beginning to realize our greatest potential. Learn more about East Jefferson General Hospital and our legacy, our future, and our national recognition as a Nurse Magnet Hospital.

Your extras
  • Deliver healthcare with heart.
  • Give people a reason to smile.
  • Put a little love in your work.
  • Be honest and real, but with compassion.
  • Bring some lagniappe into everything you do.
  • Forget one-size-fits-all, think one-of-a-kind care.
  • See opportunities, not problems - it's all about perspective.
  • Cheerlead ideas, differences, and each other.
  • Love what makes you, you - because we do


You are welcome here.

LCMC Health is an equal opportunity employer. All qualified applicants receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability status, protected veteran status, or any other characteristic protected by law.

The above job summary is intended to describe the general nature and level of the work being performed by people assigned to this work. This is not an exhaustive list of all duties and responsibilities. LCMC Health reserves the right to amend and change responsibilities to meet organizational needs as necessary.

Simple things make the difference.

1. To get started, take your time to fully and accurately complete the application for employment. Incomplete applications get bogged down and are often eliminated due to missing information.

2. To ensure quality care and service, we may use information on your application to verify your previous employment and background.

3. To keep our career applications up-to-date, applications are inactive after 6 months and, therefore, require a new application for employment to be completed.

4. To expedite the hiring process, proof of citizenship or immigration status will be required to verify your lawful right to work in the United States.

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