Credentialing Specialist

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

📋 Description

• Prepare applications for provider enrollment and/or written link letters for both new and existing providers.

• Generate and submit enrollment applications for new groups upon contract execution.

• Proactively follow up with payers regarding submitted applications and letters to obtain approval notices.

• Ensure that all providers and groups are revalidated in a timely manner.

• Collaborate with providers and team members to address payer issues and verify participating status.

• Manage documentation, upload it to a shared drive, and keep Modio updated.

• Monitor provider licensure and communicate with providers prior to expiration.

• Complete, update, and maintain CAQH profiles for providers.

• Identify and report potential enrollment issues that may lead to revenue loss.

• Build and sustain relationships with provider representatives for effective communication.

• Set up provider portals and maintain access for team members as required.

• Engage in team meetings and communications regularly.

• Carry out specific tasks as assigned by the Revenue Cycle Director.

⛳️ Requirements

• Adhere to regulatory requirements, including all federal, state, local regulations, and standards set by accrediting organizations.

• Familiarity with enrollment processes and requirements for government and commercial payers.

• A minimum of 3 years of experience in provider enrollment is required.

• Preferred experience with Modio Health.

• Detail-oriented, organized, and capable of multitasking effectively.

• Possess strong interpersonal and organizational skills.

• Exceptional customer service abilities are essential.

• Ability to thrive in a fast-paced, acquisitional environment.

• Represent the organization positively and professionally.

• Demonstrated knowledge and experience in provider enrollment.

• Comply with all organizational policies concerning ethical business practices.

• Proficiency in all Microsoft Office applications is required.

• Candidates must disclose any current or future need for employment-based immigration sponsorship (including, but not limited to, OPT, STEM OPT, or visa sponsorship) prior to receiving a job offer.

🏝️ Benefits

• Medical, Dental, Vision, and additional benefits such as Life Insurance, Short-Term and Long-Term Disability, Flexible Spending Accounts for Medical and Dependent Care, Accident, Critical Illness, and Hospital Indemnity.

• Paid Time Off.

• Paid Office Holidays.

• Paid Sick Time.

• 401(k) with up to a 3% company match.

• Referral Program.

• Payactiv: pay-on-demand. Access earned money whenever and wherever you need it!