Credentialing Specialist (50608)
Remote
Job Summary
Manage reimbursement strategy to reduce insurance denials and write-offs by analyzing root causes across modalities and payers. Design operational SOPs to prevent recurrence, conduct follow-ups with payers to resolve claim discrepancies, and track outstanding accounts receivable. Collect and verify facility/provider credentials, submit enrollment applications for Medicare, Medicaid, and commercial payors via CAQH, PECOS, and NPPES, and maintain accurate electronic files. Ensure ongoing compliance with federal and state requirements while partnering with billing and revenue cycle teams to resolve claim issues. This fully remote role supports provider onboarding at 60 Gulf Coast facilities, requiring HIPAA-compliant work environments and proficiency with web-based systems.
Required Qualifications
- Expertise in healthcare credentialing/reimbursement, preferably radiology or diagnostics
- 5+ year of experience in provider credentialing payor enrollment and denial management
- Strong knowledge of Medicare, Medicaid, and commercial insurance enrollment processes
- Proven success reducing denials and write-offs
- Ability to manage multiple providers and deadlines independently in a remote setting
- Excellent written and verbal communication skills
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