Revenue Cycle Credentialing Specialist

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

📋 Description

• Oversee the implementation of contracts in collaboration with both internal and external stakeholders.

• Administer the credentialing processes for both government and commercial contracts.

• Prepare and sustain credentialing documentation and reports for all payers.

• Submit and manage applications with third-party payers.

• Conduct follow-ups until approval from payers is achieved.

• Enroll providers in Medicare and Medicaid programs.

• Monitor expiration dates for licensure, accreditation, and insurance certificates.

• Address re-credentialing requests from payers.

• Respond to inquiries and process requests from stakeholders regarding credentialing information.

⛳️ Requirements

• An associate's degree in healthcare administration, public health, business administration, or a related field; or a high school diploma/general education diploma accompanied by 2 years of pertinent experience in lieu of an associate's degree.

• A minimum of 1 year of contracting experience within the healthcare sector.

• Proven knowledge of both public and private Managed Care payers along with reimbursement processes.

• Solid understanding of market-related issues, contract development, negotiation, and execution, including the legal and regulatory factors associated with contracting for private and government payers.

• Basic proficiency in Microsoft Office applications, including Word, Excel, Access, Outlook, and PowerPoint.

• Eligibility to work in the United States without the need for sponsorship.

🏝️ Benefits

• Health insurance coverage.

• 401(k) matching program.

• Paid time off policies.

• Flexible work arrangements available.