Credentialing Professional

2 weeks ago

Baton Rouge, Louisiana, United States Louisiana Primary Care Association Full time

Credentialing Specialist Job Description

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The Credentialing Specialist plays a crucial role in organizing and maintaining the credentialing process for LPCACO network practitioners, ensuring seamless adoption of the core credentialing platform (CredentialStream by VerityStream) among member Health Centers. This position is responsible for implementing activities, reviewing credentialing data to protect integrity, and establishing support functions related to the program.

  • Develop expertise in CredentialStream to ensure proper configuration supporting internal credentialing requirements of LPCACO providers.
  • Provide end-user training and ongoing support on CredentialStream for Health Center staff.
  • E nsure workflows and processes supported by CredentialStream meet credentialing file requirements for all licensed and certified staff in compliance with Federal Tort Claims Act (FTCA) requirements.
  • Identify and recommend improvements to workflows and processes to enhance 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 required primary source verifications and searches for new and current providers and coordinate with human resources for criminal background checks.
  • Prepare and maintain credentialing files and reports for individual providers including software maintenance, provider rosters, and spreadsheets to comply with group delegation requirements.
  • Facilitate communication between providers, Health Center credentialing staff, credentialing committees, health plans, and regulatory bodies as needed.
  • Accept and process requests from payors for credentialing information/updates/new contracts and products.
  • Complete Medicare and Medicaid revalidation applications to ensure certifications remain active and in good standing with CMS.
  • Adhere to HIPAA guidelines.

Key Requirements

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  • High school diploma or GED; at least 2 years of experience directly related to the duties and responsibilities specified.

Preferred Qualifications

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  • Certified Provider Credentialing Specialist (CPCS) Certification.
  • 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.

Salary Estimate: $55,000 - $65,000 per year, based on national averages for similar positions in the United States.

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