Credentialing Specialist

Credentialing Specialist

Louisiana Primary Care Association

Baton Rouge, LA

Supervisor : Credentialing Manager

Position Summary :

The Credentialing Specialist is responsible for organizing, maintaining, and verifying all aspects of the credentialing process for the LPCACO network practitioners including gaining adoption from the LPCACO member Health Centers for the core credentialing platform (CredentialStream by VerityStream), ensuring that implementation activities are completed, actively reviewing credentialing data to protect data integrity, and establishing and maintaining key support functions related to the program.

Duties and Responsibilities :

• Assist the Credentialing Manager to 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.
• Assist the Credentialing Manager in assisting new and renewing providers with privileging and credentialing applications;

monitor completion and follow-up as needed.

• Assist the Credentialing Manager in tracking license and certification expirations for all licensed staff to ensure timely renewals and maintain current copies of licensure for DEA, State License, and professional liability.
• Assist the Credentialing Manager in conducting required National Databank and OIG searches for new and current providers.
• Assist the Credentialing Manager in processing all requests from payors for credentialing information / updates / new contracts and products.
• Adhere to HIPAA guidelines.
• Any other duties as deemed necessary by the supervisor.

Minimum Job Requirements :

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

Knowledge, Skills, and Abilities Required :

• 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.
23 days ago