Credentialing and Provider Enrollment Specialist
: Job Details :

Our partner, a small community hospital, is looking for a dedicated Credentialing and Provider Enrollment Specialist to join their team. This vital role is responsible for overseeing the credentialing, re-credentialing, and enrollment processes for healthcare providers who seek privileges and plan participation in Louisiana. This role ensures that all providers meet the necessary qualifications, licenses, and regulatory compliance to provide high-quality healthcare services in accordance with Louisiana state laws and regulations.

Salary Range from $50,000 - $65,000.

Responsibilities:

• Credentialing & Re-Credentialing: Handle the processing of initial and renewal credentialing applications for healthcare providers, ensuring all information is accurate and verified, including education, licensure, and experience.
• Provider Enrollment: Manage the enrollment process for healthcare providers with Medicare, Medicaid, and commercial insurance plans, ensuring successful submission and resolving any issues that arise.
• Compliance & Regulatory Oversight: Stay current on Louisiana healthcare regulations and accreditation requirements, ensuring compliance with bodies like the Joint Commission and NCQA.
• Data Management & Documentation: Maintain and update confidential records in credentialing systems, generating reports and providing insights to stakeholders as needed.
• Communication & Collaboration: Serve as a key point of contact between providers, insurance companies, and internal teams, facilitating smooth and efficient communication throughout the credentialing and enrollment process.

Requirements:

Education: Associate's or Bachelor's degree in healthcare administration, business, or a related field (preferred).

Experience: At least 2 years of experience in credentialing and provider enrollment, ideally in a healthcare environment.

Certifications: Certified Provider Credentialing Specialist (CPCS) or Certified Professional Medical Services Management (CPMSM) certification preferred.

Skills:

• Exceptional attention to detail and organizational abilities
• Strong communication and interpersonal skills
• Proficiency in credentialing software and Microsoft Office Suite
• Ability to manage multiple priorities and meet deadlines
• In-depth knowledge of Louisiana healthcare regulations and accreditation standards

If you're ready to make a positive impact in healthcare by ensuring that providers meet all necessary standards and regulatory requirements, we encourage you to apply!

For more information and discuss your qualifications, please contact:

John Franz

...@principalhealthcaresolutions.com

614-###-####