Certified Credentialing Specialist
2 days ago
The Louisiana Primary Care Association is a membership organization of Federally Qualified Health Centers (FQHCs) and supporters committed to promoting accessible, affordable, quality primary healthcare services for the uninsured and medically underserved populations in Louisiana.
Job SummaryWe are seeking an experienced Credentialing Manager to oversee the successful operations of our credentialing program. This role will be responsible for gaining adoption from member health centers for our core credentialing platform, ensuring compliance with state, federal, accreditation, and health plan credentialing and enrollment requirements.
Key Responsibilities:- Internal Credentialing: Ensure the credentialing platform is configured properly to support internal credentialing requirements, standardizing workflows and processes across health centers.
- Review Monthly Releases: Monitor system updates and enhancements to ensure a stable credentialing environment, communicating important changes to participants and providing end-user training as needed.
- Privileging and Credentialing: Assist new and renewing providers with applications, track license and certification expirations, and maintain current copies of licenses and certifications.
- Primary Source Verifications: Conduct required verifications and searches, coordinating with human resources for completion of background checks.
- Process Improvement: Identify opportunities to enhance workflow, work processes, and patient care, collaborating with team members to implement improvements.
- Payor Enrollment Module: Set up the payor enrollment module to enable health centers to process and file applications with third-party payors according to each payor's requirements.
- Delegated Credentialing Agreements: Develop and implement a strategy for obtaining and maintaining delegated credentialing agreements with payors, including identifying payors, preparing applications, negotiating agreements, and maintaining ongoing compliance and reporting.
- Provider Enrollment: Ensure health centers maintain credentials with third-party payors, enrolling practitioners and facilities in Medicare/Medicaid.
- Bachelor's degree.
- At least five years of credentialing experience, preferably in FQHC settings.
- Certified Provider Medical Services Management (CPMSM) or Certified Provider Credentialing Specialist (CPCS) Certification preferred.
- Strong technical skills and database management abilities, with experience with credentialing software such as CredentialStream.
This is an excellent opportunity to join our team and contribute to the success of our mission. We offer a competitive salary of approximately $$84,000 per year, depending on qualifications and experience.
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