Credentialing Representative 2 (HYBRID)

Our Lady of the Lake Regional Medical Center • Baton Rouge, LA

315d • Hybrid

About The Position

The Credentialing Specialist is responsible for credentialing compliance with each entity's Medical Staff bylaws, rules and regulations, policies and procedures, The Joint Commission, NCQA, and federal and state regulations, as applicable to the customer. The Credentials Specialist is responsible for analysis of credentialing files, membership requests and renewals for all facilities where providers practice on behalf of FMOL, reappointment activities, malpractice enrollment and renewal, management and maintenance of supervision/collaboration status of Allied Health Professionals with respective state boards and payer enrollment. Relies on education, critical thinking skills, and judgment to accomplish job. Ability to process and manage applications. Works under general supervision. Creativity and some latitude is expected to complete responsibilities.

Requirements

• 4 years experience in a healthcare entity that includes payor interactions and/or credentialing.
• 1 year credentialing experience performing all the functions of the credentialing process.
• High school diploma.
• Special Skills: Microsoft Applications, Computer Literacy, Data Entry, Internet Searching Abilities.

Responsibilities

• Coordinates and provides appropriate guidance to the provider customers during initial credentialing, privilege delineation, reappointment activities, malpractice enrollment and renewal, and payer enrollment.
• Manages applications, verifies credentials, and monitors various industry databases for evidence of potentially adverse information for leadership review.
• Red flags potentially adverse information for leadership review and identifies areas where practitioners may not meet privileging or membership criteria.
• Manages and maintains malpractice coverage for internal and external activities.
• Maintains enrollment with all payers and supervises/collaborates with Advanced Practice Professionals with respective state boards.
• Assures that all documentation reflects that required activities are undertaken by individual evaluators and leaders.
• Notifies applicant and appropriate internal customer leader personnel of any actions taken.
• Initiates information collection, verification, and documentation process upon receipt of a complete application.
• Coordinates and facilitates review/recommendation and approval processes.
• Maintains the CAQH, Apogee and FMOL Credentialing databases to ensure accurate information.
• Monitors expirables (DEA, CDS, licensure, medical malpractice insurance, board certification) and maintains and updates the credential file.

What This Job Offers

• Industry: Hospitals
• Education Level: High school or GED
• Number of Employees: 5,001-10,000 employees