Revenue Cycle Credentialing Specialist

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

📋 Description

• Facilitate the execution of contracts by proactively and reactively engaging with internal and external stakeholders to ensure that the public and private payer contract documentation and credentialing align with corporate objectives, contracts, and regulations.

• Prepare and sustain credentialing files and reports for all payors and governmental bodies.

• Broaden both government and commercial payor profiles to encompass all lines of business units resulting from mergers and acquisitions; fulfill updates mandated by contracts for credentialing, disclosure, and demographic data.

• Manage and submit applications to third-party payors in accordance with each payor’s specific requirements and address discrepancies as requested by payors.

• Execute all follow-up actions until payor approval, completion, and acceptance are achieved.

• Update NPI records based on provider specifications.

• Enroll providers in Medicare/Medicaid in line with each program's requirements.

• Monitor licensure, accreditation, and insurance certificate expiration dates to ensure timely processing and compliance with state and federal contractual agreements with payors.

• Complete re-credentialing requests for payors, both commercial and governmental entities.

• Accept and process all requests from payers for credentialing information, updates, and new contracts and assays.

• Respond to questions, inquiries, and process requests from all internal and external stakeholders regarding credentialing information.

• Enroll all business units in Medicare/Medicaid programs.

• Address enrollment deficiencies and payor-related issues concerning commercial and government entities.

• Assist with electronic funds transfer (EFT) and electronic data interchange (EDI) enrollment, tracking, and filing.

• Act as a liaison between parent subsidiaries, third-party billing agents, payors, commercial and government entities, and all stakeholders to ensure effective revenue/reimbursement management.

• Maintain historical data and records.

• Collaborate with multiple departments to provide updates and remain informed of current initiatives that could influence credentialing and enrollment.

• Monitor incoming emails for Odxclaimsupport, Payor Credentialing, GovTeam, ManagedCareContracts, Contact ManagedCare, and CommercialOpsFax.

⛳️ Requirements

• Associate's degree in healthcare administration, public health, business administration, or a related field; or a high school diploma/general education diploma with 2 years of relevant experience in place of an Associate's degree.

• At least 1 year of contracting experience within the healthcare sector.

• Proven knowledge of public and private Managed Care payers and their reimbursement processes.

• Demonstrated understanding of market-related issues, contract development, negotiation, and execution, along with the legal and regulatory implications associated with private and governmental payer contracts.

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

• Proven ability to perform the essential duties of the position with or without accommodation.

• Authorization to work in the United States without sponsorship.

🏝️ Benefits

• Paid time off (including vacation days, holidays, volunteering, and personal time).

• Paid leave for parents and caregivers.

• A retirement savings plan.

• Wellness support.

• Health benefits including medical, prescription drug, dental, and vision coverage.