[Hiring] Payor Credentialing Specialist @Articularis Healthcare Group

Role Description

Payor Credentialing Specialist has responsibility for the timely completion of complex government and commercial payer enrollment applications for all clinicians within CAQH and other credentialing entities, maintaining and updating information from all providers, and credential verification is submitted and authenticated. The Payor Credentialing Specialist will maintain contracts with all payer sources, updating a list of paneled staff, and communicating any difficulties to management promptly. Position has remote working opportunity.

As a Payor Credentialing Specialist, typical duties might look like:

• Work with contracted providers to meet all their credentialing service expectations outlined in their contract.
• Complete the processes to enroll and credential providers (e.g. physicians, facilities, physician assistants, nurse practitioners, etc.) with insurances while meeting payor criteria.
• Complete the processes to re-credential existing providers.
• Gather and maintain current data and documents for all providers in an organized and complete way.
• Follow up with clients and insurances for timely credentialing process(es).
• Clearly and effectively communicate with providers, Operations Managers and insurance companies handling basic questions dealing with the day-to-day operation of credentialing and enrollments.
• Review, and update if necessary, health plan directories, agencies, and other appropriate entities for current and accurate provider information.
• Knowledge of computer spreadsheets and other related applications.
• Knowledge of provider credentialing/accreditation/insurance regulations, policies, guidelines, and standards.
• Other duties as assigned.

Qualifications

• Associates degree in business, healthcare related field required or equivalent experience.
• Experience in credentialing, privileging or other medical experience relevant to insurance carrier credentialing, re-credentialing and follow up preferred.
• Must have excellent written and verbal communication skills as well as the ability to observe, assess, guide and evaluate others.
• High level of awareness of pertinent details; excellent organizational skills.
• Must handle pressure effectively.
• Bachelors degree in business, healthcare related field preferred or equivalent experience.

Benefits

• 4-day work week
• Benefits package that includes group medical, dental, vision, short-term & long-term disability insurance, paid holidays, PTO and 401K.

Next Steps

Once you submit your application, a member of our Talent Acquisition Team will review your resume and application. A team member will reach out to you within a week to schedule a phone screening.

EEO/AA-M/F/disabled/protected veteran

*Reasonable accommodations may be made to enable individuals with disabilities to perform the essential function.