Provider Credentialing Specialist

Lakeland Care • Fond du Lac, WI

1d

About The Position

We're growing - Join our award winning culture as we serve members in your area! Position Summary: The Provider Credentialing Specialist develops and maintains a network of high quality and culturally competent service providers to meet members’ needs through the establishment of service provider contracts, ensuring contracted providers maintain compliance with all required regulations applicable to the contracted service(s). This position monitors providers’ credentials, licenses, negotiates rates, finalizes contracts, and compliance with Lakeland Care provider selection and retention policies. The Provider Credentialing Specialist creates, develops, monitors, and maintains provider electronic records needed to substantiate credentialing and contract compliance.

Requirements

• Bachelor’s degree in a human service field, business related field, or equivalent combination of education and experience (includes knowledge, skills, and abilities).
• Exceptional organizational skills, accuracy, and precision in record-keeping activities are required.
• Strong communication, determination, and ability to motivate others are necessary.
• Current driver’s license, acceptable driving record and proof of adequate insurance required.

Nice To Haves

• Experience working with the population(s) served in the Family Care program preferred.
• Experience in provider credentialing in a health insurance and/or managed care environment is preferred.
• Knowledge of health care/long-term care service provider industry, subcontracting, and licensing and regulatory systems is preferred.
• Knowledge of network provider contracting in a managed long-term care model is preferred.

Responsibilities

• Complete credentialing and re-credentialing applications, including conducting follow-up with providers to ensure all required documentation is received.
• Compile and maintain current, accurate data for all current and incoming providers.
• Collaborate with providers in LCI’s Contracting and Certification processes.
• Negotiate provider reimbursement in accordance with the LCI rate bands.
• Monitor timelines for renewal of required documents and collaborate with contracted providers to ensure that compliance with requirements and subsequent eligibility to provide services do not lapse.
• Support providers with basic questions on understanding and interpreting terms of the Lakeland Care service provider contract.
• Provide education to contracted providers regarding the Family Care program and state statutes.
• Participation in External Quality Review (EQR) Process.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Number of Employees: 101-250 employees