Credentialing Specialist

Description

We are seeking a detail-oriented Credentialing Specialist to join our healthcare team, focusing on orthopaedic provider credentialing. This remote position plays a crucial role in maintaining the highest standards of patient care and regulatory compliance by managing the credentialing process for our orthopaedic healthcare providers.

The Virtual Credentialing Specialist will ensure the accurate verification and maintenance of healthcare provider credentials through:

•  Managing the comprehensive credentialing lifecycle for providers, including initial applications, reappointments, and ongoing monitoring of compliance requirements 
•  Conducting thorough primary source verification of medical education, training, licensure, and board certifications 
•  Maintaining detailed digital records and updating credentialing databases with precision and timeliness 
•  Coordinating with insurance payers for provider enrollment and network participation 
•  Proactively tracking and managing credential renewal deadlines to ensure continuous compliance 
•  Investigating and resolving credentialing discrepancies through appropriate channels 
•  Generating regular status reports and compliance updates for leadership review 

Requirements

Required Qualifications

•  Minimum of 2 years' experience in healthcare credentialing 
•  Demonstrated proficiency in electronic credentialing management systems 
•  Strong understanding of healthcare regulations and accreditation standards 
•  Excellent organizational skills with exceptional attention to detail 

Preferred Qualifications

•  NAMSS Certification (CPCS or CPMSM) 
•  Experience with Louisiana State Board of Medical Examiners (LSBME), Louisiana Board of Nursing and Pharmacy
•  Demonstrated proficiency with Louisiana Medicaid and MCO credentialing requirements
•  Familiarity with the Council for Affordable Quality Healthcare (CAQH)
•  Experience with Louisiana hospital privileging systems 
•  Understanding of Louisiana Workers' Compensation Medical Treatment Guidelines for orthopaedic care 
•  Familiarity with the Louisiana Uniform Credentialing Program