Credentialing/Payor Specialist

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

📋 Description

• Create and implement strategies aimed at minimizing insurance denials and payer write-offs.

• Identify, assess, and prioritize the root causes of denials and non-payments across various modalities, payers, and locations.

• Develop and execute systematic solutions to avert recurring denials.

• Recognize denial trends and translate them into operational Standard Operating Procedures (SOPs).

• Engage with payers to address claim denials and payment discrepancies.

• Investigate delays in payments and reimbursements while assisting in accurate claims processing.

• Oversee and monitor outstanding accounts receivable.

• Collect, verify, maintain, and update credentials for facilities and providers.

• Prepare and submit initial and re-credentialing applications.

• Maintain electronic files for credentialing and track expiration and renewal dates.

• Submit enrollment applications for providers to Medicare, Medicaid, and commercial payors.

• Manage enrollments through platforms such as CAQH, PECOS, NPPES, and specific payor portals.

• Follow up with payors regarding delays, missing documents, and application issues.

• Verify provider participation status and effective dates.

• Keep fee schedules updated.

• Update payors with provider demographics, locations, group affiliations, and tax information.

• Maintain compliance documentation for audits and internal assessments.

• Collaborate with billing, revenue cycle, and leadership teams to address credentialing- and enrollment-related claim challenges.

• Communicate with internal teams via email, phone, and virtual meetings.

• Independently manage workload while adhering to deadlines and productivity goals.

⛳️ Requirements

• Expertise in healthcare credentialing and reimbursement, ideally in radiology or diagnostics.

• Over 5 years of experience in provider credentialing, payor enrollment, and denial management.

• Strong understanding of enrollment processes for Medicare, Medicaid, and commercial insurance.

• Proven track record of successfully reducing denials and write-offs.

• Capable of managing multiple providers and deadlines independently in a remote environment.

• Exceptional written and verbal communication abilities.

• Highly detail-oriented and driven by deadlines.

• Comfortable with regular follow-ups and tracking documentation, especially in accounts receivable.

• Proficient in Microsoft Office and web-based systems.

• Self-motivated and capable of working autonomously in a remote setting.

• Maintains confidentiality and professionalism.

• Reliable internet access is required.

• Ability to sustain a secure, HIPAA-compliant remote work environment.

🏝️ Benefits

• Fully remote work arrangement.

• Secure, HIPAA-compliant remote work environment.

• Flexible independent workload management.