Credentialing Specialist

6 days ago

Baton Rouge, Louisiana, United States Louisiana Primary Care Association Full time
Credentialing Specialist Job Description

The Credentialing Specialist is a crucial role at the Louisiana Primary Care Association, responsible for ensuring the accuracy and efficiency of the credentialing process for our network practitioners. This position requires a strong understanding of medical provider credentialing and accreditation principles, policies, processes, procedures, and documentation.

Key Responsibilities:
  • Build and maintain expertise in the CredentialStream platform to ensure it is configured properly to support the internal credentialing requirements of our providers.
  • Provide Health Center end-user training and ongoing support around CredentialStream.
  • Ensure that the workflows and processes supported by CredentialStream will meet the credentialing files for all licensed and certified staff in compliance with Federal Tort Claims Act (FTCA) requirements.
  • Identify and recommend improvements to workflows and processes to improve accuracy and efficiency of the credentialing process.
  • Assist new and renewing providers with privileging and credentialing applications; monitor completion and follow-up as needed; prepare credentialing files for committee review.
  • Maintain licensed staff information in a centralized location.
  • Track license and certification expirations for all licensed staff to ensure timely renewals.
  • Track expirations and maintain current copies of licenses, DEA, board certifications, CPR training, and professional liability.
  • Conduct all applicable required primary source verifications and searches (e.g., National Databank, SAM, OIG, NPI, etc.) for new and current providers and coordinate with human resources for completion of required criminal background checks.
  • Prepare and maintain credentialing files and reports for all individual providers including maintenance of credentialing software, provider rosters and spreadsheets to comply with group delegation requirements, as required.
  • Facilitate communication between providers, Health Center credentialing staff, credentialing committees, health plans, and regulatory bodies as needed.
  • Accept and process all requests from payors for credentialing information/updates/new contracts and products.
  • Complete Medicare and Medicaid revalidation applications in a timely manner to ensure all certifications are kept active and in good standing with CMS.
  • Adhere to HIPAA guidelines.
Requirements:
  • High school diploma or GED; at least 2 years of experience directly related to the duties and responsibilities specified.
  • Certified Provider Credentialing Specialist (CPCS) Certification preferred.
  • Strong technical skills and database management skills. Experience with CredentialStream or other web-based credentialing software preferred.
  • Ability to communicate effectively both orally and in writing.
  • Customer service skills.
  • Ability to respond to emails timely and effectively.
  • Information research skills.
  • Knowledge of medical provider credentialing and accreditation principles, policies, processes, procedures, and documentation.
  • Working knowledge of clinical and/or hospital operations and procedures.
  • Ability to use independent judgment and to manage and impart confidential information.
  • Ability to maintain confidentiality and discretion in all communications on behalf of credentialing applicants and/or applications.
  • Demonstrated advanced working knowledge of Microsoft Word and Excel.
  • Ability to learn new applications to function effectively in a remote work environment.
  • Skill in establishing priorities with independent coordination of day-to-day aspects.

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