Payer Credentialing Specialist

Job Summary:

The Payer Credentialing Specialist is responsible for the enrollment of new providers at our current facilities and clinics for various insurance companies as well as Medicare and Medicaid. Requires working knowledge of the Revenue Cycle and the importance of securing all appropriate information between providers and payers to maximize reimbursement. This also includes any payer re-credentialing or validation for the providers at facilities and clinics in a timely manner as requested by the payer. Will work in the credentialing system (echo) and keep all current payer status up to date. Assist in providing any additional needed documentation to payors that directly impacts their active status to ensure it does not negatively impact payment. Assist in completion of necessary paperwork with payers that may involve a change of ownership or change in designation for any facility/clinic. Will work closely and communicate effectively to department heads, clinic director/managers, as well as the billing offices when their area is impacted. Reach out to payers/reps on provider status. Keep all provider updates current in CAQH. Will work with any third-party vendor that may be assisting us in billing when payer credentialing needs arise. Will reach out to the necessary provider/facility/clinics to obtain documentation or signature in order for enrollment to be complete. All other duties assigned.

Performance Expectations:

• Responsible for completing provider insurance applications in a timely manner.
• Demonstrates accurate ability to create and format letters, emails, documents and other correspondence.
• Able to follow instructions with minimal supervision
• Begins assignments without supervision and takes the appropriate action to resolve any issues
• Ensure confidentiality of provider information and records
• Responsible for updating credentialing information with various insurance companies and databases
• Responsible for the re-credentialing of all facilities, clinics and billable providers
• Responsible for keeping all information organized and easily accessible when needed
• Communicates effectively and timely on any payer-related issues to the Director of Revenue Systems

Qualifications:

Education/Skills

Bachelor’s Degree in related field and/or work-related experience in the health insurance industry or healthcare provider setting. Payer enrollment and healthcare billing experience is highly recommended.

Work Experience:

Understanding of provider credentialing and its direct impact on the organizations revenue cycle. Excellent computer skills including Excel, Word, and Internet. Detail oriented with above average organizational skills. Plans and prioritizes to meet deadlines. Excellent customer service skills; communicates clearly and effectively. Ability to work independently and as a team player.

Mental Demands:

• Work well under pressure
• The ability to engage in deductive reasoning
• Critical thinking
• Exhibit strong attention to detail and accuracy
• Observe and meet deadlines
• Strong Oral and written communication skills