Credentialing Specialist

Posted:
9/3/2024, 6:03:44 AM

Location(s):
Louisiana, United States ⋅ Baton Rouge, Louisiana, United States

Experience Level(s):
Junior ⋅ Mid Level ⋅ Senior

Field(s):
Medical, Clinical & Veterinary

Mary Bird Perkins Cancer Center is Louisiana’s leading cancer care organization, caring for more patients each year than any other facility in the region. And with strategic hospital and physician partnerships, we are delivering on our mission to improve survivorship and lessen the burden of cancer.

Mary Bird Perkins and its partners work together to provide state-of-the-art treatments and unparalleled collaborative, comprehensive cancer services. This culture of innovation helps attract the best cancer minds in the country, from expert physicians and highly specialized scientists to forward-thinking leaders in supportive care and other disciplines.

Together, with our hospital and physician partners, we are one-hundred percent focused on cancer care.

Why Join Us? We are looking for talented and highly-motivated individuals who demonstrate a natural desire to support the meaningful work of community oncologists and the patients we serve.

Job Description:

Scope of Position: Responsible for ensuring that Mary Bird Perkins Cancer Center (MBPCC), St. Elizabeth-Mary Bird Perkins Cancer Center (STEMBPCC), Southeast Louisiana Radiation Oncology Group (SLROG), Louisiana Hematology Oncology Associates (LHOA), Northshore Oncology Associates (NOA) and Cancer Care Specialists (CCS) are in compliance with Federal, State and other licensing standards by maintaining the credentials for practitioners / medical staff with licensure agencies, hospitals, private payors, and managed care companies.  Provide administrative support for MBP medical staff to maintain Federal, State, and other licensing regulatory standards.  

Provide administrative support and assistance to the Medical Staff Office (MSO). Requires efficient organization and execution of projects / coordination of daily office functions / directly related experience and knowledge of general office procedures / an understanding of Center operations and the skills required to meet the changing job requirements / professional communication with medical staff.

ESSENTIAL FUNCTIONS:

  • 1. Submit and maintain payer credentialing applications for providers
  • 2. Update tracker of submission dates of new applications monitor current applications, and track recredentialing dates for existing enrollments.
  • 3. Respond to health plan providers inquiries.
  • 4. Monitor licenses and credentialing expiration dates and advise providers of required "renew by" dates, along with submitting these renewals in a timely manner.
  • 5. Ensure the providers are maintaining compliance with regulatory and accrediting institutions.
  • 6. Maintain records and effectively communicate with team members on updates/statuses.
  • 7. Submit and maintain facility applications for providers' hospital privileges.
  • 8. Maintain the continuing medical education certificates for compliance with the Louisiana Board of Medical Examiners requirements.
  • 9. Conduct research on updated insurance regulations and policies.
  • 10. Help develop internal credentialing processes with growth of the company.

QUALIFICATIONS:

  • Associates degree in an applicable field desired.
  • Minimum 2 years of credentialing experience
  • Proficiency in Microsoft Office including applications in word processing, spreadsheets, database, presentation, and flowchart software.