Credentialing and Billing Operations Specialist – Part-Time

Red Cell Partners; United States; Remote; Part time

Job summary

A leading healthcare startup is seeking a part-time Credentialing and Billing Operations Specialist. This fully virtual role focuses on managing the credentialing process and ensuring accurate claim reimbursements. Ideal candidates will thrive in a startup environment and possess extensive experience in healthcare credentialing and billing management.

Qualifications

• Extensive experience in healthcare provider credentialing & enrollment.
• Knowledge of payer enrollment processes, CAQH, NPPES, PECOS.

Responsibilities

• Manage the initial credentialing and re-credentialing of healthcare providers.
• Track and follow up on application statuses to ensure timely approval.
• Coordinate with the RCM vendor to resolve billing discrepancies.

Skills

Healthcare Provider Credentialing

Billing Management

Attention to Detail

Problem Solving

Tools

Microsoft Office

Credentialing Software

Job description

Credentialing and Billing Operations Specialist – Part-Time

Remote

About Us

Red Cell Partners is an incubation firm building and investing in rapidly scalable technology-led companies that are bringing revolutionary advancements to market in three distinct practice areas: healthcare, cyber, and national security. United by a shared sense of duty and deep belief in the power of innovation, Red Cell is developing powerful tools and solutions to address our Nation’s most pressing problems.

Location: Virtual

Reports to: VP Strategy & Operations

Work Schedule: Part-time

Company Overview:

Savoy Life is a healthcare startup focused on improving senior living. Savoy Life’s model of care aims to supportsenior living communities and help tie residents, their caregivers, and the providers within the community together. This is done by partnering with senior living communities to coordinate and manage clinical gaps for residents to improve these facilities’ core business drivers. We deploy our own team of clinical experts both in-person and virtually paired with technology to provide instant leverage and relief for the facilities’ staff and fill gaps in care not always met by existing providers in the community. We honor residents’ existing care team including primary care via wraparound services to give residents the high-quality care and support they deserve, on their terms.

Job Overview:

Savoy Life is seeking part-time Credentialing and Billing Operations Specialist to support credentialing, billing as it relates to health plan setup and monitoring, and ad hoc operational needs. This is a fully virtual role that will largely work independently with the critical focus on owning the end-to-end credentialing and enrollment process. This starts with identifying health plans/IPAs to contact, reaching out to those companies, setting up Savoy’s entity plus providers, and monitoring. The second critical aspect of this role is insuring that the credentialing setup translates into accurate and timely claim reimbursement by managing payer configurations (ERA, EDI, eligibility) in Savoy’s EHR and coordinating with the RCM vendor to resolve billing discrepancies.

This part-time role will start out focused only on credentialing for max 15 hours a week. If successful, this role can rapidly ramp up and add more responsibilities and therefore more hours. This is a 1099 position with the goal of converting to a W2.

Key Responsibilities:

• As Savoy enters new states, identify and prioritize health plans and IPA groups to reach out to as well as the processes to do so
• Manage and drive the initial credentialing and re-credentialing of healthcare providers with health plans and IPA groups (Medicare, Medicaid, Commercial plans, etc.) including identifying contacts to reach out to when barriers arise such as leveraging leadership’s LinkedIn contacts
• Prepare, review, and submit enrollment applications and supporting documentation to health plans and IPAs
• Track and follow up on application statuses to ensure timely approval
• Maintain and update provider credentialing files in accordance with regulations
• Communicate with insurance companies and the internal team to resolve credentialing and enrollment issues
• Collect, review, and validate credentials for our clinical team including licenses, certifications, and education
• Ensure compliance with federal, state, and payer-specific requirements
• Maintain a credentialing database ensuring all required documents are up to date and complete
• Setup and maintain Electronic Remittance Advice (ERA), Electronic Data Interchange (EDI), and eligibility verification connections within the EHR system.
• Monitor and verify that claims are paid in accordance with contracted rates and credentialing setup for each payer and provider
• Coordinate with the RCM vendor to resolve discrepancies between credentialed status and actual reimbursement received as well as troubleshoot issues related to claim denials, eligibility rejections, or enrollment lapses
• Validate provider IDs, NPI numbers, and taxonomies are correctly configured in billing and EHR platforms

Operations

• Provide additional pockets of support such as managing Savoy’s accounts payable platform to approve and complete invoices (platform is very user friendly) and managing vendor contracts through an AI tool

Required Qualifications:

• Extensive experience in healthcare provider credentialing & enrollment as well as at least light billing management
• Credentialing experience must extend beyond working at a health plan and must be comfortable starting the credentialing process from scratch
• Knowledge of payer enrollment processes, CAQH, NPPES, PECOS, and insurance verification
• Proficiency in Microsoft Office (Excel, Word, Outlook) and credentialing software

What You Bring:

• Comfortable working with little to no structure and building structure from the ground up (this is a startup, and this is the only role to support credentialing today) paired with clear expectations of outputs
• Ability and desire to learn and grow with a belief in the growth mindset
• Strong attention to detail, organizational, and communication skills
• Strengths with working proactively and problem solving independently before escalating support

Compensation:$25-$35/hour

We’re an Equal Opportunity Employer: You’ll receive consideration for employment without regard to race, sex, color, religion, sexual orientation, gender identity, national origin, protected veteran status, or on the basis of disability.

Apply for this job

*

indicates a required field

First Name *

Last Name *

Email *

Phone *

Resume/CV *

Enter manually

Accepted file types: pdf, doc, docx, txt, rtf

Enter manually

Accepted file types: pdf, doc, docx, txt, rtf

LinkedIn Profile

Website

Do you have authorization to work in the United States? * Select...

Will you require sponsorship now or in the future? * Select...

Have you submitted and followed up on credentialing applications to health plans/IPAs on behalf of your company, rather than processing applications as part of a health plan’s internal team? * Select...

Do you have experience reaching out to health plans directly to initiate the credentialing process at the entity/group level? Said differently, have you setup credentialing with a health plan or IPA from scratch? * Select...

Have you setup EDI & ERAs? * Select...

Are you comfortable working with little to no structure and building structure from the ground up? * Select...

Voluntary Self-Identification

For government reporting purposes, we ask candidates to respond to the below self-identification survey.Completion of the form is entirely voluntary. Whatever your decision, it will not be considered in the hiringprocess or thereafter. Any information that you do provide will be recorded and maintained in aconfidential file.

As set forth in Red Cell Partners’s Equal Employment Opportunity policy,we do not discriminate on the basis of any protected group status under any applicable law.

If you believe you belong to any of the categories of protected veterans listed below, please indicate by making the appropriate selection.As a government contractor subject to the Vietnam Era Veterans Readjustment Assistance Act (VEVRAA), we request this information in order to measurethe effectiveness of the outreach and positive recruitment efforts we undertake pursuant to VEVRAA. Classification of protected categoriesis as follows:

A "disabled veteran" is one of the following: a veteran of the U.S. military, ground, naval or air service who is entitled to compensation (or who but for the receipt of military retired pay would be entitled to compensation) under laws administered by the Secretary of Veterans Affairs; or a person who was discharged or released from active duty because of a service-connected disability.

A "recently separated veteran" means any veteran during the three-year period beginning on the date of such veteran's discharge or release from active duty in the U.S. military, ground, naval, or air service.

An "active duty wartime or campaign badge veteran" means a veteran who served on active duty in the U.S. military, ground, naval or air service during a war, or in a campaign or expedition for which a campaign badge has been authorized under the laws administered by the Department of Defense.

An "Armed forces service medal veteran" means a veteran who, while serving on active duty in the U.S. military, ground, naval or air service, participated in a United States military operation for which an Armed Forces service medal was awarded pursuant to Executive Order 12985.

Select...

Voluntary Self-Identification of Disability

Form CC-305

Page 1 of 1

OMB Control Number 1250-0005

Expires 04/30/2026

Voluntary Self-Identification of Disability

Form CC-305 Page 1 of 1 OMB Control Number 1250-0005 Expires 04/30/2026
Why are you being asked to complete this form?

We are a federal contractor or subcontractor. The law requires us to provide equal employment opportunity to qualified people with disabilities. We have a goal of having at least 7% of our workers as people with disabilities. The law says we must measure our progress towards this goal. To do this, we must ask applicants and employees if they have a disability or have ever had one. People can become disabled, so we need to ask this question at least every five years.

Completing this form is voluntary, and we hope that you will choose to do so. Your answer is confidential. No one who makes hiring decisions will see it. Your decision to complete the form and your answer will not harm you in any way. If you want to learn more about the law or this form, visit the U.S. Department of Labor’s Office of Federal Contract Compliance Programs (OFCCP) website at www.dol.gov/ofccp .

How do you know if you have a disability?

A disability is a condition that substantially limits one or more of your “major life activities.” If you have or have ever had such a condition, you are a person with a disability. Disabilities include, but are not limited to:

• Alcohol or other substance use disorder (not currently using drugs illegally)
• Autoimmune disorder, for example, lupus, fibromyalgia, rheumatoid arthritis, HIV/AIDS
• Blind or low vision
• Cancer (past or present)
• Cardiovascular or heart disease
• Celiac disease
• Cerebral palsy
• Deaf or serious difficulty hearing
• Diabetes
• Disfigurement, for example, disfigurement caused by burns, wounds, accidents, or congenital disorders
• Epilepsy or other seizure disorder
• Gastrointestinal disorders, for example, Crohn's Disease, irritable bowel syndrome
• Intellectual or developmental disability
• Mental health conditions, for example, depression, bipolar disorder, anxiety disorder, schizophrenia, PTSD
• Missing limbs or partially missing limbs
• Mobility impairment, benefiting from the use of a wheelchair, scooter, walker, leg brace(s) and/or other supports
• Nervous system condition, for example, migraine headaches, Parkinson’s disease, multiple sclerosis (MS)
• Neurodivergence, for example, attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder, dyslexia, dyspraxia, other learning disabilities
• Partial or complete paralysis (any cause)
• Pulmonary or respiratory conditions, for example, tuberculosis, asthma, emphysema
• Short stature (dwarfism)
• Traumatic brain injury

Disability Status Select...

PUBLIC BURDEN STATEMENT: According to the Paperwork Reduction Act of 1995 no persons are required to respond to a collection of information unless such collection displays a valid OMB control number. This survey should take about 5 minutes to complete.