Senior Provider Enrollment & Credentialing Coordinator

LSU Health Sciences Center New Orleans; New Orleans (LA); On-site; USD 40,000 - 60,000; Full time

Job summary

The LSU Healthcare Network seeks a Senior Provider Enrollment & Credentialing Coordinator to manage provider enrollment and credentialing processes. The role involves analytical functions, compliance checks, and effective communication with stakeholders. Candidates should have relevant experience and be well-versed in credentialing practices.

Benefits

15 PTO Days

11 Paid Holidays

401(k) Plan with employer match

Health Insurance

Tuition Reimbursement

Qualifications

• Minimum of 3 years of related experience.
• Experience with MD Staff or similar systems preferred.
• Preferred background in academic medical center or health insurance.

Responsibilities

• Perform analytical provider enrollment and credentialing functions.
• Audit materials for accuracy and completeness.
• Identify variances and address them in a timely manner.

Skills

Analytical skills

Attention to detail

Communication skills

Customer service skills

Problem-solving skills

Education

Bachelor's degree or equivalent

Tools

MD Staff or similar credentialing systems

Microsoft Excel

Job description

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The LSU Healthcare Network is a non-profit, academic, multi-specialty, healthcare delivery system dedicated to patient care, research and education. You can be a part of a progressive healthcare team making a meaningful difference in the care of patients. The LSU Healthcare Network is made up of over 175 healthcare providers – from primary care to specialty care – at several multi-specialty care locations in and around the Greater New Orleans area.

We offer a competitive compensation and benefits package including:

• 15 PTO Days
• 11 Paid Holidays
• 401(k) Plan with employer match (dollar for dollar up to 6% of employee contribution)
• Health Insurance
• Tuition Reimbursement

POSITION SUMMARY

The Senior Provider Enrollment & Credentialing Coordinator performs analytical provider enrollment and credentialing functions with payers, vendors, and practices.

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

ESSENTIAL DUTIES AND RESPONSIBILITIES

Description:

SUMMARY

The LSU Healthcare Network is a non-profit, academic, multi-specialty, healthcare delivery system dedicated to patient care, research and education. You can be a part of a progressive healthcare team making a meaningful difference in the care of patients. The LSU Healthcare Network is made up of over 175 healthcare providers – from primary care to specialty care – at several multi-specialty care locations in and around the Greater New Orleans area.

We offer a competitive compensation and benefits package including:

• 15 PTO Days
• 11 Paid Holidays
• 401(k) Plan with employer match (dollar for dollar up to 6% of employee contribution)
• Health Insurance
• Tuition Reimbursement

POSITION SUMMARY

The Senior Provider Enrollment & Credentialing Coordinator performs analytical provider enrollment and credentialing functions with payers, vendors, and practices.

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

ESSENTIAL DUTIES AND RESPONSIBILITIES

Technical

• Identifies variances, issues, and delays, addressing them in a timely manner, escalating with internal and external stakeholders and management as needed.
• Performs ongoing outreach and follow-up with providers, payers and vendors, ensuring that contractual obligations in terms of turnaround timeframes, credentialing and loading requirements are met, escalating when deficiencies are identified.
• Audits materials returned by providers, payers, and vendors for accuracy and completeness, addressing variances in a standardized way according to well-defined standard operating procedures.
• Prepares and distributes status updates to stakeholders for accurate and timely updating of internal and external platforms (including but not limited to databases, credentialing grids, dictionaries, portals, and websites).
• Serves as a key contributor to special credentialing, enrollment, and operational projects, including large-scale initiatives and centralization of additional services and functions.
• Performs compliance checks and quality assurance activities to maintain the integrity of data and ensure adherence to standard operating procedures. Proficient in excel to utilize v-lookup, pivot tables, concatenation, and other reporting tools to validate data from multiple sources.
• Troubleshoots credentialing associated denials/underpayments, collaborating with stakeholders to complete a comprehensive root-cause analysis, following through to resolution to minimize adverse impact to revenue and patient/provider abrasion.
• Identifies trends impacting multiple providers, payers and/or groups. Prepares and distributes status reports, making recommendations for next steps and escalating to internal and external stakeholders.
• Performs scheduled and ad-hoc audits of payer and vendor data ensuring updates are made in credentialing database and discrepancies are addressed with external parties.
• Administers credentialing processes in accordance with NCQA and URAC guidelines, including quality assurance and compliance tasks, delegated credentialing payer audits/reporting, and coordination of Credentialing Committee processes.
• Establish and maintain positive relationships with payers, providers, practices and administration, providing subject matter expertise and tailoring communications to adapt to each audience.
• Effectively communicates through informal and formal presentations for various audiences to ensure relevant communication are cascaded to the various interest and stakeholder groups as needed.

Strategy

• Works collaboratively with fellow team members to regularly evaluate the effectiveness of department Standard Operating Procedures and workflows and identify gaps. Provides feedback and recommendations to supervisor for improvements.
• Implements approved changes.

People

• Mentors others in individual and team accountability, modeling behavior, and demonstrating best practices/techniques.

Other

• Performs other related duties as assigned within the scope of practice.
• Maintain familiarity and stay current with NCQA / URAC requirements and health insurance plan procedures.
• Conforms to all applicable HIPAA, Billing Compliance, and safety policies and guidelines.

Requirements:

EDUCATION and/or EXPERIENCE

• Bachelor's degree or equivalent in education and experience.
• A minimum of 3 years of related experience.
• Prior experience with MD Staff or similar credentialing systems is preferred.
• Prior experience at an academic medical center or health insurance plan is preferred.

KNOWLEDGE, SKILLS & ABILITIES

• Specialized knowledge of managed care Credentialing/Enrollment.
• Must demonstrate advanced analytical and problem-solving skills with attention to detail and accuracy.
• Intermediate knowledge of Microsoft Excel (e.g. vlookup, pivot tables, etc.) or similar software is required.
• Advanced time management skills including planning, organization, multi-tasking, and ability to prioritize required.
• Must demonstrate effective communication skills both verbally and written.
• Must be a motivated individual with a positive and exceptional work ethic.
• Ability to work collaboratively with a culturally diverse staff, strong customer service skills, demonstrating tact and sensitivity in stressful situations.
• Must successfully complete systems training requirements.
  

Seniority level

• Seniority level

  Mid-Senior level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Health Care Provider

• Industries

  Higher Education

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