What are the responsibilities and job description for the Credentialing and Provider Enrollment Specialist position at Principal Healthcare Solutions?
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.
Manage the enrollment process for healthcare providers with Medicare, Medicaid, and commercial insurance plans, ensuring successful submission and resolving any issues that arise.
Stay current on Louisiana healthcare regulations and accreditation requirements, ensuring compliance with bodies like the Joint Commission and NCQA.
Maintain and update confidential records in credentialing systems, generating reports and providing insights to stakeholders as needed.
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
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
johnfranz@principalhealthcaresolutions.com
614-408-1131
Salary : $50,000 - $65,000
