Provider Credentialing Specialist (Org Wide)

Lakeland Care Incorporated • Fond Du Lac, WI

1d

About The Position

The Provider Credentialing Specialist develops and maintains a network of high-quality, culturally competent service providers to meet members’ needs. The role establishes service provider contracts and ensures that contracted providers comply with regulations applicable to their services. It monitors provider credentials and licenses, negotiates rates, finalizes contracts, and ensures compliance with Lakeland Care provider selection and retention policies. The specialist creates, develops, monitors, and maintains electronic provider records to substantiate credentialing and contract compliance.

Requirements

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

Nice To Haves

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

Responsibilities

• Complete credentialing and re-credentialing applications, following up with providers to obtain required documentation.
• Compile and maintain current, accurate data for current and incoming providers.
• Collaborate with providers during LCI’s Contracting and Certification processes.
• Negotiate provider reimbursement in accordance with LCI rate bands.
• Monitor renewal timelines for required documents and work with contracted providers to prevent lapses in compliance or eligibility to provide services.
• Support providers with basic questions about understanding and interpreting Lakeland Care service provider contract terms.
• Educate contracted providers about the Family Care program and state statutes.
• Participate in the External Quality Review (EQR) process.

What This Job Offers

• Job Type: Full-time