Insurance Credentialing and Contracting Agent, US Healthcare

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

📋 Description

• Oversee the credentialing process for newly onboarded clinicians, ensuring that documentation and portal profiles are updated with individual insurers for compliance and accurate billing.

• Investigate the insurance landscape in new states as the company grows, determining which insurers should be prioritized for network inclusion.

• Contact insurance providers to gather insights on credentialing requirements, application processes, and reimbursement rate structures.

• Negotiate reimbursement rates with insurers when the offered rates are below competitive standards.

• Monitor the progress of credentialing and contracting, proactively identifying and addressing any delays or issues.

• Keep precise, audit-ready records across various insurer portals and systems.

• Adhere to established workflows and escalate issues as necessary.

• Perform additional coordination tasks as required.

⛳️ Requirements

• Experience in U.S. health insurance, encompassing private insurers and Medicaid.

• Exceptional communication abilities with strong proficiency in English (both verbal and written).

• Robust critical thinking and independent problem-solving skills, especially in the realm of contracting and negotiation.

• A confident and proactive demeanor, comfortable initiating communication with insurers and advocating for improved terms.

• Detail-oriented and highly organized, with the discipline to accurately manage multiple portals and meet deadlines.

• Basic computer skills, including familiarity with MS Office and Outlook (advanced Excel skills are not necessary).

• Familiarity with ABA-specific insurance processes is a valuable asset, though not mandatory.

• Capability to work independently with minimal daily supervision.

🏝️ Benefits

• Competitive salary and performance-based incentives.

• Comprehensive health insurance plans.

• Opportunities for professional development and growth.

• Flexible work arrangements to support work-life balance.