Description

We've made a lot of progress since opening the doors in 1942, but one thing has never changed - our commitment to serve, heal, lead, educate, and innovate. We believe that every award earned, every record broken and every patient helped is because of the dedicated employees who fill our hallways.

At Ochsner, whether you work with patients every day or support those who do, you are making a difference and that matters. Come make a difference at Ochsner Health and discover your future today!

The Payor Credentialing Specialist is responsible for coordinating, monitoring, and maintaining provider enrollment with all government payors in a timely and compliant manner. This role facilitates all aspects of the credentialing and enrollment lifecycle, including initial enrollment, re-enrollment, and ongoing monitoring for physicians and advanced practice providers. In addition, the specialist plays a key role in identifying and resolving payor-related issues, particularly those impacting claim submission and denial management. By ensuring prompt issue resolution and accuracy in enrollment records, this position supports optimal reimbursement and revenue cycle performance.

Education

Required - High School diploma or equivalent

Preferred- Credentialing or other health care revenue cycle related experience

Work Experience

• Skill in effective oral, written, and interpersonal communication.
• Skill in time management and project management.
• Ability to work efficiently under pressure.
• Ability to operate a computer and related applications, especially Microsoft Office applications.
• Ability to work independently and take initiative.
• Ability to demonstrate a commitment to continuous learning and to operationalize that learning.
• Ability to deal effectively with constant changes and be a change agent.
• Ability to deal effectively with challenging situations.

Job Duties

• Facilitate enrollment of new Ochsner providers to ensure proper and timely billing and collections
• Prepare enrollment applications for all government plans including Medicare, Medicaid, and Tricare
• Complete data entry and processing of enrollment applications, with validation of provider submitted information to ensure the application is complete, accurate, and meeting departmental standards
• Obtain licensure, certification and insurance certificates at time of enrollment and maintain in database in order to submit with enrollment applications
• Maintain timelines on enrollment processes and address and/or escalate any delays
• Ensure that all pending enrollments are reviewed, obtained and managed according to the rules and policies of the department
• Follow up with necessary contacts, including providers and operations leaders, to resolve enrollment application issues and deficiencies
• Demonstrate a level of competence and understanding of all state and federal laws, rules and regulations according to payer guidelines for billing
• Respond to internal and external inquiries on routine enrollment matters, as appropriate
• Maintain confidentiality of all provider enrollment business/work and medical staff information

Other related duties as required. The above statements describe the general nature and level of work only. They are not an exhaustive list of all required responsibilities, duties, and skills. Other duties may be added, or this description amended at any time.

Ochsner is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status, or disability status.

Physical and Environmental Demands
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Medium Work - Exerting 20 to 50 pounds of force occasionally, and/or 10 to 25 pounds of force frequently, and/or greater than negligible up to 10 pounds of force constantly to move objects. (Constantly: activity or condition exists 2/3 or more of the time) to move objects. Physical demand requirements are in excess of those for Sedentary Work. Even though the weight lifted may be only a negligible amount, a job should be rated Light Work: (1) when it requires walking or standing to a significant degree; or (2) when it requires sitting most of the time but entails pushing and/or pulling of arm or leg controls; and/or (3) when the job requires working at a production rate pace entailing the constant pushing and/or pulling of materials even though the weight of those materials is negligible. NOTE: The constant stress and strain of maintaining a production rate pace, especially in an industrial setting, can be and is physically demanding of a worker even though the amount of force exerted is negligible.

Mechanical lifting devices (carts, dollies, etc.) or team lifts should be utilized.
Must be able to sit for prolonged periods of time.
Must be able to work a flexible work schedule (e.g. 24/7, weekend, holiday, on call availability).

Normal routine involves no exposure to blood, body fluid or tissue and as part of their employment, incumbents are not called upon to perform or assist in emergency care or first aid.

There is no occupational risk for exposure to communicable diseases

Are you ready to make a difference? Apply Today!

Ochsner Health does not consider an individual an applicant until they have formally applied to the open position on this careers website.

Please refer to the job description to determine whether the position you are interested in is remote or on-site. Individuals who reside in and will work from the following areas are not eligible for remote work position: Colorado, California, Hawaii, Illinois, Maryland, Massachusetts, Minnesota, New Jersey, New York, Vermont, Washington, and Washington D.C.

Ochsner Health endeavors to make our site accessible to all users. If you would like to contact us regarding the accessibility of our website, or if you need an accommodation to complete the application process, please contact our HR Employee Solution Center at 504-842-4748 (select option 1) or careers@ochsner.org. This contact information is for accommodation requests only and cannot be used to inquire about the status of applications.

Ochsner is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to any legally protected class, including protected veterans and individuals with disabilities.