[Hiring] Credentialing & Health Insurance Specialist @RightSite Health

Role Description

The Credentialing and Health Insurance Specialist will be responsible for managing all aspects of the provider licensing and credentialing process including health plan network participation across multiple states. This dynamic role requires a strong understanding of licensing and credentialing, attention to detail, and the ability to work independently as well as collaboratively with other departments. As a crucial member of our team, you will leverage your expertise to optimize revenue cycles, ensure compliance with state and federal regulations, and contribute to the financial health of our organization. Your skills in navigating complex state and federal licensing systems and health plan network systems will be instrumental in maintaining smooth operations.

A Day in the Life

• New Provider Onboarding: IMLC, Licensure, Medicare, Medicaid, DEA
• Maintenance and Verification on external sites: CAQH, NPPES, PECOS, Availity, etc.
• Provider Renewals: IMLC, Licensure, Nurse Compact
• Health Plans – Applications, follow up, Contracting and Credentialing for FFS
• Health Plan Maintenance - Credentialing
• Health Plan requirements such as specific trainings
• Database and effective date input and management
• Password Management
• Billing Partner support: effective dates, passwords, specific health plan issues
• Policies and Procedures for Physician Credentialing/Contracting
• Communication to Operations to support Provider scheduling

Qualifications

• Bachelor’s degree in healthcare administration, business, or related field or equivalent work experience
• Minimum 2 years of experience in provider onboarding
• Proficiency in health plan networks
• Strong knowledge of licensing, credentialing, Medicare and Medicaid
• Familiarity with HIPAA regulations and privacy standards

Requirements

• Provider Licensure/Credentialing: Comprehensive knowledge of licensure and credentialing and ability to apply that knowledge to multiple states and provider types.
• Attention to Detail: Meticulous focus on accuracy when handling provider information, licensure data, and records.
• Problem Solving Skills: Ability to analyze complex licensure issues, identify discrepancies, and develop effective solutions.
• Communication: Proficiency in clearly conveying complex licensure/credentialing issues to Operations.
• Technical Proficiency: Strong aptitude for using and adapting to various billing software, electronic health record systems, and data analysis tools.

Benefits

• The opportunity to be a part of a dynamic, mission-driven organization
• Competitive base salary
• Market-competitive healthcare coverage, including medical, dental, vision, life, and disability
• The opportunity to work alongside talented and professional colleagues with the ability to grow