Credentialing & Enrollment Specialist

State of Louisiana; Hammond (LA); On-site; USD 27,000 - 52,000; Full time

Job summary

Florida Parishes Human Services Authority seeks an Administrative Program Specialist B (Credentialing) in Hammond, LA to manage credentialing for licensed clinical and medical staff with payers. You will work independently, coordinating applications, enrollments, and recredentialing while ensuring accuracy in records and timely billing.

The ideal candidate has strong interpersonal skills, knowledge of CAQH, and experience with HIPAA and regulatory compliance.

Qualifications

• Four years of experience in administrative services.
• Six years of full-time work experience in any field plus one year of experience in administrative services.
• A bachelor's degree plus one year of experience in administrative services.
• An advanced degree.
• EXPERIENCE SUBSTITUTION: Every 30 semester hours earned from an accredited college or university will be credited as one year of experience towards the six years of full-time work experience in any field. The maximum substitution allowed is 120 semester hours which substitutes for a maximum of four years of experience in any field.

Responsibilities

• Managing provider and clinic credentialing, recredentialing, and enrollment with Medicaid, Medicare, managed care organizations, commercial insurance carriers, and other third-party payers, ensuring timely applications, revalidations, and continued participation.
• Maintaining accurate provider and clinic enrollment and credentialing records, including provider rosters, specialty and taxonomy assignments, practice locations, payer participation, and required documentation.
• Coordinating provider additions, changes, terminations, and payer roster updates, while monitoring credentialing requirements and resolving issues that could affect billing, service authorizations, claims payment, or agency revenue.
• Researching and resolving credentialing-related claim denials, reimbursement issues, and enrollment discrepancies in coordination with billing staff, the Utilization Coordinator, insurance carriers, and other payer representatives.
• Serving as the primary liaison with insurance companies and payers regarding provider contracting, enrollment, credentialing, participation, authorization-related matters, and changes to payer requirements.
• Monitoring payer policies, bulletins, newsletters, provider manuals, contracts, and participation agreements and communicating updates and potential operational impacts to leadership and relevant departments.
• Maintaining CAQH profiles and credentialing compliance, including monitoring professional licenses, certifications, DEA registrations, malpractice insurance, and other requirements and ensuring current documentation is submitted to CAQH and payer portals.
• Maintaining organized, secure, and confidential credentialing and billing documentation in accordance with agency policies, payer requirements, HIPAA, record-retention schedules, and applicable regulations, including preparing records for audits, reviews, medical record requests, and compliance activities.

Skills

Driving results

Policy adherence

Judgment accuracy

Education

Four years of experience in administrative services

Six years of full-time experience plus one year in admin services

Bachelor's degree plus one year in administrative services

Advanced degree

Experience substitution rules

Job description

Florida Parishes Human Services Authority seeks an Administrative Program Specialist B (Credentialing) in Hammond, LA to manage credentialing for licensed clinical and medical staff with payers. You will work independently, coordinating applications, enrollments, and recredentialing while ensuring accuracy in records and timely billing.

The ideal candidate has strong interpersonal skills, knowledge of CAQH, and experience with HIPAA and regulatory compliance.