Credentialing and Denials Specialist
RemoteUnited States or Denver, Colorado, United States
United States or Denver, Colorado, United StatesRemoteFull TimeMid LevelLicense Or CertificationSmall
Full TimeMid LevelLicense Or CertificationSmall
Job Summary
Manage provider credentialing, enrollment, and privileging with commercial and government payers, hospitals, and healthcare organizations to ensure uninterrupted clinical operations and timely reimbursement. Investigate denied claims, research root causes, and appeal denials through review of coding, medical records, and payer guidelines to maintain accurate revenue cycle performance. Maintain credentialing records and monitor compliance with licenses, certifications, and regulatory standards while collaborating with internal teams to resolve reimbursement issues and support quality improvement initiatives.
Required Qualifications
- Minimum of two (2) years of experience in provider credentialing, payer enrollment, medical billing, denial management, or revenue cycle operations
- Demonstrated experience researching, appealing, and resolving insurance claim denials
- Working knowledge of medical terminology, provider taxonomy, commercial and government payer guidelines, credentialing requirements, and healthcare reimbursement methodologies
- High School Diploma or GED
- Proficiency in Microsoft Outlook, Word, Excel, internet research, and payer portals
Desired Qualifications
- Hospital credentialing and privileging experience
- Knowledge of hospital credentialing and privileging processes
- Excellent analytical, organizational, problem-solving, and critical thinking skills
- Demonstrated commitment to exceptional customer service through professional communication, responsiveness, and timely follow-up
- Ability to work independently while effectively managing multiple competing priorities and consistently meeting deadlines
- Strong written and verbal communication skills
- Experience with EPIC Resolute Professional Billing
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