Credentialing Associate

JOB OVERVIEW:

The Credentialing Associate is responsible for ensuring that healthcare providers are properly enrolled with insurance companies, government programs, and other third-party payers to ensure proper reimbursement for services provided.

Target Pay Range: $28-30/hr - Compensation to be determined by the education, experience, knowledge, skills, and abilities of the applicant, internal equity, and alignment with market data.

Benefits:

• 3 Weeks PTO + 8.5 days of additional sick time + 10 paid holidays
• Paid parental leave
• 100% Employer Paid Medical, Dental, and Vision Insurance
• Employer Paid STD & LTD
• 401k
• $50 monthly Remote Work Stipend

This is a full-time (40hrs per week) remote position.

RESPONSIBILITIES:

• Ensure all necessary documents (licenses, contracts, tax information, etc.) are submitted to payors and are current to meet enrollment and revalidation requirements.
• Act as the point of contact for resolving enrollment issues, such as rejections, delays, or discrepancies, by communicating directly with payors.
• Monitor and track revalidation deadlines for providers to ensure timely re-enrollment and prevent disruptions in reimbursement.
• Maintain records and provide reports on the status of payor enrollments, including completed, pending, and rejected applications.
• Ensure timely re-attestation of CAQH profiles.
• Regular and predictable attendance is required.
• All other duties as assigned.

QUALIFICATIONS:

• Minimum 1-3 years experience in credentialing and payor enrollment, including maintaining in-network contracts/enrollments with private and public payors.
• Knowledge of State Medicaid (including Managed Medicaid Care Organizations), Medicare, commercial/private health plans, and insurance carriers.
• Knowledge of PECOS system.
• Experience working with major payors like UnitedHealthcare, Aetna, Cigna, Blue Cross Blue Shield, etc.
• Strong attention to detail and accuracy.
• Excellent organizational and prioritization skills.
• Team-oriented with a collaborative mindset.

• Receptive to feedback and continuous improvement.

• Certification in payer enrollment, healthcare administration, or a related field is a plus (e.g., Certified Professional Coder - CPC or other relevant certifications).

• Experience working from home is preferred. Consistent access to a private work environment with high speed internet and professionally appropriate surroundings for frequent video conferencing and a workstation setup conducive to remote work needs.

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