Credentialing Specialist

This is a fully remote position, open to applicants in Australia.

📋 Description

• Oversee the submission of provider enrollment applications for designated states characterized by intricate regulations or a high volume of providers.

• Act as the expert on credentialing and enrollment criteria in the assigned states.

• Stay updated on both in-network and out-of-network enrollment procedures.

• Collaborate with Account Coordinators to verify provider information and documentation.

• Foster relationships with payor representatives to address issues and ensure prompt resolutions.

• Prepare and submit provider enrollment paperwork via payor portals and traditional mail.

• Monitor application statuses and perform proactive follow-ups.

• Manage re-credentialing submissions and inform Account Management of upcoming client requirements.

• Complete quarterly and other mandatory payor attestations.

• Provide daily status updates to the Credentialing Coordinator.

• Keep records of submissions, follow-ups, and payor communications in internal tracking systems.

• Achieve performance metrics, including timely submissions, accurate applications, daily reporting, and a denial rate below 1%.

⛳️ Requirements

• Minimum of 2 years of college education.

• Two years of experience in a US-based medical billing practice or two years of experience in a medical practice related to billing, including provider credentialing, authorizations, reimbursement, etc.

• Preferably some experience in Behavioral Health.

• Outstanding attention to detail and strong organizational capabilities.

• Critical thinking and problem-solving skills in complex or unclear situations.

• Ability to work efficiently in a fast-paced, deadline-oriented environment.

• Clear and professional verbal and written communication skills.

• Strong reading comprehension with the ability to interpret regulatory and procedural documentation.

• Professional yet assertive communication style when interacting with payors.

• Must possess a personal computer and reliable internet connection.

• Candidates are responsible for managing their own benefits and taxes.

🏝️ Benefits

• Permanent remote work opportunity.

• Immediate hiring process.

• Stable freelance position.

• Profit-sharing incentives.

• Paid time off.

• Holiday pay.

• Annual performance reviews and salary evaluations.

• Quarterly incentives for perfect attendance.

• Health Maintenance Organization (HMO) benefits.

• BruntWork Loan Assistance.