Description:
A meticulous and detail-oriented specialist with a deep understanding of the healthcare administrative landscape, this candidate thrives on navigating complex regulatory requirements. They possess a proactive mindset, aiming to bridge the gap between healthcare providers and insurance networks to ensure seamless revenue cycles.
Experience
- The ideal candidate must have a minimum of 5 years of dedicated experience in medical credentialing and provider enrollment.
- This background should include extensive work with diverse medical specialties, high-volume group practices, and independent clinics, with a proven track record of managing end-to-end insurance paneling and re-credentialing cycles within the US healthcare sector.
Key Responsibilities
- You will manage the full lifecycle of provider credentialing and re-credentialing, including NPI registration, CAQH profile maintenance, and PECOS/Medicare enrollment.
- Daily duties involve submitting accurate applications to commercial and government payers, monitoring application status via payer portals, resolving credentialing-related claim denials, and ensuring all provider documentation remains compliant with state and federal regulations.
Required Skills
- Technical mastery of CAQH, PECOS, NPPES, and Availity is essential, alongside proficiency in EHR/PM systems such as Epic, Cerner, Athenahealth, and eClinicalWorks.
- Soft skills must include exceptional organizational capabilities, precise written communication for high-stakes correspondence with insurance carriers, and the ability to handle sensitive provider data with absolute confidentiality.
Education & Certification
- A Bachelor's degree in Healthcare Administration, Business Administration, or a related field is preferred.
- Candidates should hold relevant industry certifications such as the Certified Provider Credentialing Specialist (CPCS) or Certified Professional Medical Services Management (CPMSM) to demonstrate technical mastery.
Additional Requirements
- Beyond the core experience, we value candidates with a deep understanding of state-specific Medicaid nuances, experience in multi-state licensing verification, and a history of utilizing Office Ally or Practice Fusion for streamlined document management.
- Bilingual capabilities and advanced proficiency in Microsoft Excel for reporting are highly desirable.