Job Details

Administrative Program Specialist B

Come join our team at Florida Parishes Human Services Authority as an Administrative Program Specialist B and help keep our provider and clinic credentialing and enrollment processes running smoothly. If you are organized, detail-oriented, and enjoy working with providers, insurance companies, and internal staff, this is a great opportunity to support accurate billing, timely payments, and quality services for the individuals we serve! An ideal candidate shall possess the following competencies:

• 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.

Minimum Qualifications:

• Four years of experience in administrative services; OR
• Six years of full-time work experience in any field plus one year of experience in administrative services; OR
• A bachelor's degree plus one year of experience in administrative services; OR
• An advanced degree.

Experience substitution: Every 30 semester hours earned from an accredited college or university will be credited as one year of experience towards the six years of full-time work experience in any field. The maximum substitution allowed is 120 semester hours which substitutes for a maximum of four years of experience in any field.

Job Duties and Other Information:

• Managing provider and clinic credentialing, recredentialing, and enrollment with governmental and commercial insurance 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.

Position-Specific Details:

• Appointment Type: Probational
• Career Progression: This position will be filled as an Administrative Program Specialist B
• Compensation: The salary range for the position is below.
• Location: Executive Administration/Billing Department is housed in Hammond, Louisiana.

How To Apply:

No Civil Service test score is required 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). Resumes will not be accepted in lieu of completed education and experience sections on your application. Applications may be rejected if incomplete.

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

emily.barthelemy@fphsa.org