Provider Credentialing Specialist

1 week ago


Lafayette, Louisiana, United States Community Care Partners Full time
Job Summary

Community Care Partners is seeking a highly organized and detail-oriented Credentialing and Enrollment Coordinator to join our team. As a key member of our medical staff services team, you will be responsible for coordinating, monitoring, and maintaining the credentialing and provider enrollment process in a timely and compliant manner.

Key Responsibilities
  • Credentialing and Enrollment: Obtain and verify provider information and documentation necessary for all health plans, including Medicare, Medicaid, and Managed Medicaid.
  • Application Submission and Processing: Manage and follow up on submission and processing of applications within the appropriate timeframe with all health plans/payors.
  • Provider Maintenance: Ensure providers obtain and maintain medical malpractice insurance and update internal and external databases as needed.
  • Verification and Audits: Ensure primary source verifications occur for internal processing and external customers, and assist with audits as needed.
  • Status Changes and Terminations: Process all status changes and terminations with respect to payors.
  • Communication and Customer Service: Communicate directly with internal and external customers to ensure all requirements are completed accurately and timely, providing excellent customer service.
Requirements
  • Education and Experience: Bachelor's degree preferred; will consider candidates with experience in medical staff services or certified Professional Medical Staff Management (CPMSM) and/or Certified Provider Credentialing Specialist (CPCS) in lieu of degree.
  • Skills and Abilities: Extensive knowledge of Microsoft Suite and other programs specific to the company; excellent communication skills, both verbal and written; strong organizational and time management skills; high level of accuracy and attention to detail; ability to multitask and prioritize.


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