Administrative Program Specialist B-FiscalBilling

• Driving Results: The ability to set and pursue goals maintain focus amid competing demands and deliver results.
• Following Policies and Procedures: The ability to follow reinforce adapt or develop policies and procedures to maintain compliance with federal and state legal requirements State Civil Service rules and organizational policies.
• Making Accurate Judgments: The ability to assess options weigh risks and make sound decisions using available information and logical reasoning.

The official job specifications for this role as defined by the State Civil Service can be found here.

Job Duties:
This position serves as a Credentialing Specialist for the agency and is responsible for the initial and ongoing credentialing recredentialing and enrollment of licensed clinical and medical staff with governmental and commercial insurance payers. The incumbent must work independently and demonstrate a high level of both interpersonal and communication skills (verbal and written).

Duties of this position include:

• 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.

• Administrative Program Specialist B:$19.30/hour minimum - $37.88/hour maximum

How To Apply:

No Civil Service testscore isrequired in order to be considered for this vacancy.

To apply for this vacancy click on the Apply link above and complete an electronic application which can be used for this vacancy as well as future job opportunities. Applicants are responsible for checking the status of their applications to determine where they are in the recruitment process. Further status message information is located under the Information section of the Current Job Opportunities page.

*Information to support your eligibility for this job title must be included in the application (i.e. relevant detailed experience/education).Resumeswill not be accepted in lieu of completed education and experience sections on your application. Applications may be rejected if incomplete.

Contact Information:

For further information on this vacancy please contact:

Emily Barthelemy

HR Analyst C

Florida Parishes Human Services Authority

835 Pride Drive Suite B

Hammond LA 70401