Credentialing Specialist

• Develop and execute strategies to reduce insurance denials and payer write-offs
• Identify, analyze, and prioritize denial and non-payment root causes across modalities, payers, and sites
• Design and implement systematic solutions to prevent recurring denials
• Identify denial trends and convert them into operational SOPs
• Follow up with payers to resolve claim denials and payment discrepancies
• Investigate payment and reimbursement delays and support accurate claims processing
• Monitor and track outstanding accounts receivable
• Collect, verify, maintain, and update facility and provider credentials
• Prepare and submit initial and re-credentialing applications
• Maintain electronic credentialing files and track credential expirations and renewals
• Submit provider enrollment applications for Medicare, Medicaid, and commercial payors
• Manage enrollments through CAQH, PECOS, NPPES, and payor-specific portals
• Follow up with payors regarding delays, missing documentation, and application deficiencies
• Confirm provider participation status and effective dates
• Maintain up-to-date fee schedules
• Update payors on provider demographics, locations, group affiliations, and tax information
• Maintain compliance documentation for audits and internal reviews
• Partner with billing, revenue cycle, and leadership teams to resolve credentialing- and enrollment-related claim issues
• Communicate with internal teams via email, phone, and virtual meetings
• Manage workload independently while meeting deadlines and productivity expectations

Credentialing Specialist jobs in Louisiana

Credentialing/Payor Specialist