Credentialing Specialist

Jobtailor; Deutschland; Vor Ort; EUR 45.000 - 65.000; Vollzeit

Zusammenfassung

Jobtailor is seeking a remote Credentialing and Enrollment Specialist in Germany to lead denial management and provider enrollment processes. You will analyze denial patterns, implement solutions, and manage credentialing applications for Medicare, Medicaid, and commercial payors, while maintaining thorough AR tracking.

The role requires 5+ years in credentialing and enrollment, strong communication, and a meticulous, deadline-driven mindset.

Qualifikationen

• 5+ years of provider credentialing, payor enrollment, and denial management experience.
• Strong knowledge of Medicare, Medicaid, and commercial enrollment processes.
• Proven success reducing denials and write-offs.
• Ability to manage multiple providers and deadlines independently in a remote setting.
• Excellent written and verbal communication skills.
• Highly detail-oriented and deadline-driven.
• Confidentiality and professionalism in handling sensitive data.

Aufgaben

• Take charge of strategy to cut down insurance denials and write-offs.
• Identify root causes of denials across modalities and payers.
• Design and implement systemic solutions to prevent recurrence.
• Prepare and submit credentialing/enrollment applications for payors.
• Monitor accounts receivable and follow up with payers to resolve delays.
• Maintain credentialing files and track expiration dates.
• Collaborate with billing, revenue cycle, and leadership teams.

Kenntnisse

Denial management

Credentialing

Provider enrollment

Accounts receivable

Documentation tracking

Data analysis

Communication skills

Remote work

Tools

CAQH

PECOS

NPPES

Microsoft Office

Web-based systems

Jobbeschreibung

Take charge of the overall strategy to cut down on insurance denials and write-offs from payers
Identify, analyze, and prioritize root causes of denials and non-payment across modalities, payers, and sites
Design and implement systematic solutions to prevent recurrence
Identify denial trends and turn them into actionable operational SOP’s
Conduct follow up with payers and insurance companies to resolve claim denials and payment discrepancies
Investigate and resolve issues causing delays in payment or reimbursement, ensuring accurate claims processing
Assist in the identification of recurring denial patterns and recommend process improvement to reduce AR delays
Monitor and track outstanding accounts receivable (AR)
Collect, verify, and maintain facility/provider credentials
Prepare and submit initial and re-credentialing applications in accordance with organizational, payor, and regulatory requirements
Maintain accurate and complete electronic credentialing files
Track credential expiration dates and proactively manage renewals to prevent lapses
Complete and submit provider enrollment applications for Medicare, Medicaid, and commercial payors
Manage enrollments using CAQH, PECOS, NPPES, and payor-specific portals
Conduct regular follow-ups with payors to resolve delays, missing documentation, or application deficiencies
Confirm provider participation status and effective dates with each payor
Maintain up to date fee schedules
Update payors with changes to provider demographics, locations, group affiliations, and tax information
Ensure ongoing compliance with federal, state, and payor requirements
Maintain documentation for audits and internal reviews
Partner with billing, revenue cycle, and leadership teams to resolve credentialing- or enrollment-related claim issues

Requirements

• Expertise in healthcare credentialing/reimbursement, preferably radiology or diagnostics
• 5+ year of experience in provider credentialing payor enrollment and denial management
• Strong knowledge of Medicare, Medicaid, and commercial insurance enrollment processes
• Proven success reducing denials and write-offs
• Ability to manage multiple providers and deadlines independently in a remote setting
• Excellent written and verbal communication skills
• Highly detail-oriented and deadline-driven
• Comfortable with frequent follow-ups and documentation tracking, particularly in AR
• Proficient with Microsoft Office and web-based systems
• Self-motivated and able to work independently in a remote environment
• Always maintains confidentiality and professionalism.

Core Competencies

Demonstrates expertise in healthcare credentialing and reimbursement processes, with a strong focus on reducing denials and managing provider enrollments. Proficient in maintaining compliance with regulatory requirements and managing accounts receivable effectively.

Highest-signal resume keywords

• Healthcare Credentialing
• Denial Management
• Provider Enrollment
• Medicare and Medicaid Processes
• Accounts Receivable Management

ATS Optimization Keywords

Hard Skills

• Denial Analysis
• Claims Processing
• SOP Development
• Credentialing Applications
• Regulatory Compliance
• Process Improvement
• Documentation Tracking
• Data Analysis
• Root Cause Analysis
• Payment Reconciliation

Soft Skills

• Excellent Communication Skills
• Detail-Oriented
• Deadline-Driven
• Self-Motivated
• Professionalism

Industry Keywords

• Insurance Denials
• Accounts Receivable
• Credentialing
• Payer Relations
• Healthcare Compliance

Tools & Technologies

• Microsoft Office
• CAQH
• PECOS
• NPPES
• Web-Based Systems