Job Description

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:

• Build and maintain expertise in the CredentialStream platform to ensure it is configured properly to support the internal credentialing requirements of the LPCACO providers.
• Provide Health Center end-user training and ongoing support around CredentialStream. 
• 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.
• Identify and recommend improvements to workflows and processes to improve accuracy and efficiency of the credentialing process.
• Assist new and renewing providers with privileging and credentialing applications; monitor completion and follow-up as needed; prepare credentialing files for committee review.
• Maintain licensed staff information in a centralized location. 
• Track license and certification expirations for all licensed staff to ensure timely renewals.
• Track expirations and maintain current copies of licenses, DEA, board certifications, CPR training, and professional liability.
• Conduct all applicable required primary source verifications and searches (e.g., National Databank, SAM, OIG, NPI, etc.) for new and current providers and coordinate with human resources for completion of required criminal background checks. 
• Prepare and maintain credentialing files and reports for all individual providers including maintenance of credentialing software, provider rosters and spreadsheets to comply with group delegation requirements, as required.
• Facilitate communication between providers, Health Center credentialing staff, credentialing committees, health plans, and regulatory bodies as needed.
• Accept and process all requests from payors for credentialing information/updates/new contracts and products. 
• Complete Medicare and Medicaid revalidation applications in a timely manner to ensure all certifications are kept active and in good standing with CMS.
• Adhere to HIPAA guidelines.
• Any other duties as deemed necessary by 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:

• Certified Provider Credentialing Specialist (CPCS) Certification preferred.
• Strong technical skills and database management skills. Experience with CredentialStream or other web-based credentialing software preferred.
• 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.

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