What are the responsibilities and job description for the Credentialing and Reimbursement Specialist position at EMERGICON LLC?
The Credentialing & Reimbursement Specialist is responsible for coordinating, monitoring, and maintaining provider enrollment, re-enrollment, revalidation, and ERA/EFT processes in a timely and compliant manner.
Essential Duties And Responsibilities
- Coordinate TMHP and Medicare (MCR) revalidation processes, ensuring accuracy and compliance with deadlines
- Set up payor sites for eligibility, claim filing, claim status, ERA, EFT, and appeals
- Establish and maintain group accounts for multi-providers
- Maintain and update provider licenses and insurance addresses
- Prepare enrollment applications for all health plans, including Medicare and Medicaid
- Complete and distribute W-9 forms
- Demonstrate problem-solving and customer service skills
- Ability to understand, analyze, and interpret complex documents
- Other job-related duties as assigned
Knowledge And Experience
- High school diploma/GED required
- Minimum of 2 years of provider enrollment experience preferred, including TMHP and Medicare revalidation.
- Ability to distinguish and explain an EFT, ERA, EOB, COB, and “pay to” address
- Ability to read and understand payor applications and how payors work
- Knowledge of federal and state insurance laws and their interpretation as appropriate
- Knowledge of insurance claim processing, third-party reimbursement, and revalidation processes
- Ability to work within a deadline-intense environment prioritizing workflow as needed.
- Must be able to communicate clearly and professionally, verbally and in writing.
Emergicon requires satisfactory pre-employment drug screenings and background check.
