What are the responsibilities and job description for the Revenue Cycle & Credentialing Specialist position at Independent Pharmacy Provider Network ( IPPN )?
Revenue Cycle & Credentialing Specialist (IPPN)
Location: Remote/On-site Scottsdale, AZ
Reports To: Revenue Cycle Management Coordinator
About the Role
IPPN is seeking a detail-oriented and self-driven Revenue Cycle & Credentialing Specialist to manage key components of our internal revenue cycle processes. This role will support billing, payer enrollment, credentialing, and contracting activities across our growing network. You’ll play a central role in ensuring accurate, timely billing and provider credentialing, with a focus on efficiency, compliance, and payer relationships.
Responsibilities
Credentialing & Payer Enrollment
- Complete payer applications and credentialing packets for IPPN providers.
- Manage initial credentialing, recredentialing, and maintenance across PECOS, NPPES, I&A, CAQH, and similar systems.
- Ensure timely updates in internal and third-party credentialing platforms.
- Track credentialing status, contract expirations, and re-credentialing deadlines.
Contract & Fee Schedule Management
- Gather and review payer contracts and fee schedules.
- Compare contracted rates to actual reimbursements and identify discrepancies.
- Track contract status and facilitate renewals and renegotiations.
- Support reporting on payer performance and fee trends.
- Assist in negotiation communications with payers to align reimbursement with service costs.
Collaboration & Reporting
- Attend regular team meetings to report status updates.
- Provide updates and reports.
- Collaborate with leadership and clinical teams to improve workflows and address operational gaps.
Billing & Prior Authorization
- Oversee patient insurance and benefits eligibility.
- Establish access and maintain secure login credentials for payer sites.
- Review and release claims flowing from IPPNHub to billing platforms.
- Submit claims and resolve rejections.
- Post payments, reconcile accounts, and manage patient balances.
- Handle denial management and appeals processing.
- Work aging reports and perform account follow-ups.
- Generate and review monthly billing and financial reports.
- Support internal policy documentation for billing workflows.
Qualifications
- 3 years of experience in medical billing, RCM, or credentialing (preferably with clinical services or FQHCs).
- Familiarity with platforms such as PECOS, CAQH, NPPES, and payer portals.
- Strong understanding of insurance billing processes including Medicare and Medicaid.
- Knowledge of provider contract negotiations and fee schedule analysis a plus.
- Detail-oriented with excellent organizational and communication skills.
- Ability to work independently in a remote environment.
- Experience in pharmacy or collaborative provider models (preferred but not required).