Credentialing Specialist

Louisiana Orthopaedic Specialists

Credentialing SpecialistWe 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 requirementsConducting thorough primary source verification of medical education, training, licensure, and board certificationsMaintaining detailed digital records and updating credentialing databases with precision and timelinessCoordinating with insurance payers for provider enrollment and network participationProactively tracking and managing credential renewal deadlines to ensure continuous complianceInvestigating and resolving credentialing discrepancies through appropriate channelsGenerating regular status reports and compliance updates for leadership reviewRequired QualificationsMinimum of 2 years' experience in healthcare credentialingDemonstrated proficiency in electronic credentialing management systemsStrong understanding of healthcare regulations and accreditation standardsExcellent organizational skills with exceptional attention to detailPreferred QualificationsNAMSS Certification (CPCS or CPMSM)Experience with Louisiana State Board of Medical Examiners (LSBME), Louisiana Board of Nursing and PharmacyDemonstrated proficiency with Louisiana Medicaid and MCO credentialing requirementsFamiliarity with the Council for Affordable Quality Healthcare (CAQH)Experience with Louisiana hospital privileging systemsUnderstanding of Louisiana Workers' Compensation Medical Treatment Guidelines for orthopaedic careFamiliarity with the Louisiana Uniform Credentialing Program Louisiana Orthopaedic Specialists

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