Credentialing /Payor Specialist (49144)

Capitol Imaging Services, LLC; Metairie (LA); Presencial; USD 65.000 - 90.000; Jornada completa

Descripción de la vacante

Capitol Imaging Services seeks a Credentialing and Denial Management Specialist to optimize payer enrollment, credentialing, and claim resolution in a remote-capable role based in Metairie, LA.

The role requires 5+ years in provider credentialing and denial management, with strong Medicare/Medicaid knowledge, and proficiency with CAQH, PECOS, and NPPES.

Formación

• 5+ years in provider credentialing, enrollment, and denial management.
• Expertise with Medicare, Medicaid, and commercial payors.
• Remote-ready with strong written and verbal communication.

Responsabilidades

• Lead strategy to reduce insurance denials and write-offs.
• Analyze root causes of denials across modalities and sites.
• Design and implement processes to prevent recurrence.
• Track denial trends and translate into SOPs.
• Follow up with payers to resolve denials and discrepancies.
• Monitor AR to ensure timely payments.

Conocimientos

Healthcare credentialing

Payor enrollment

Denial management

Microsoft Office / web-based systems

Herramientas

CAQH

PECOS

NPPES

Payor portals

Descripción del empleo

Job Details: Job Location: Remote - Capitol Billing Group - Metairie, LA, Position Type: Full Time, Salary Range: Undisclosed, Job Category: Health Care,

Job Summary

Capitol Imaging Services, we’re a leading provider of diagnostic imaging services committed to delivering high-quality patient care through innovation and a compassionate approach. Our high-quality radiology services include MRI, CT, PET/CT, Nuclear Medicine, ultrasound, X-ray, and mammography. We are currently operating 60 facilities across six states in the Gulf Coast region.

Key Responsibilities

• 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 i the identification of recurring denial patterns and recommend process improvement to reduce AR delays
• Monitor and track outstanding accounts receivable (AR)

Credentialing/Payer Enrollment

• 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

Maintenance & Compliance

• 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

Remote Work Expectations

• Maintain reliable internet access and a secure, HIPAA-compliant remote work environment
• Communicate effectively with internal teams via email, phone, and virtual meetings
• Manage workload independently while meeting deadlines and productivity expectations

Qualifications

• 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

Skills & Competencies

• 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