Credentialing Specialist

Caravel Autism Health; Green Bay (WI); Hybrid; USD 60,000 - 82,000; Full time

Job summary

Caravel Autism Health, LLC is seeking a Credentialing Specialist for our Green Bay, WI office. This hybrid role requires local presence for occasional on-site work and collaboration with payors and providers.

The successful candidate will manage credentialing activities, review new payor contracts, maintain relationships with payor contacts, and support cross-departmental initiatives to streamline operations.

Qualifications

• Bachelor’s degree in a healthcare or business-related discipline, or equivalent experience
• Certification is a plus
• At least three years of medical insurance, billing or claims experience, preferably in a supervisory capacity
• Knowledge of medical billing and ICD-10, and CPT coding
• Strong interpersonal and leadership skills
• HIPAA privacy and security knowledge

Responsibilities

• Works with payors to add new locations to existing contracts.
• Maintains good working relationships with payor contacts.
• Performs initial review of new payor contracts and suggests changes to discuss with Director.
• Acts as a credentialing resource for providers.
• Ensures department operations are performed in an accurate and timely manner.
• Identifies and suggests process improvement goals to support operations.
• Develops and maintains partnerships across all other departments, partners, and vendors to support business objectives.
• Performs other duties as assigned.

Job description

This position is Hybrid--you will need to be local to our Green Bay, WI office and available for occasional on-site work.

Job Description

The Credentialing Specialist is responsible for all credentialing activities and initial analysis of new contracts.

Essential Functions:

• Works with payors to add new locations to existing contracts.
• Maintains good working relationships with payor contacts.
• Performs initial review of new payor contracts and suggests changes to discuss with Director.
• Acts as a credentialing resource for providers.
• Ensures department operations are performed in an accurate and timely manner.
• Identifies and suggests process improvement goals to support operations.
• Develops and maintains partnerships across all other departments, partners, and vendors to develop and integrate solutions in support of business objectives.
• Performs other duties as assigned

Physical Demands:

This is largely a sedentary role, with frequent sitting and computer keyboarding required. Employee will be required to sit, talk, hear, type and write. Occasional bending, squatting, stooping, and lifting (up to 35 pounds) are required.

Qualifications:

Education:

• Bachelor’s degree in a healthcare or business-related discipline, or equivalent experience
• Certification is a plus

Experience:

• At least three years of medical insurance, billing or claims experience, preferably in a supervisory capacity
• Previous management level experience preferred

Skills and Competencies:

• Knowledge of medical billing and ICD-10, and CPT coding, as well as knowledge of financial concepts
• Strategic focus, with the ability to identify and execute on key business strategies that will support attainment of overall organizational business objectives
• Ability to effectively lead, coach, manage, mentor and develop others, holding staff accountable as appropriate
• Excellent interpersonal skills, with the ability to communicate effectively with others
• Able to work both independently and be self-directed, as well as being able to perform in a team atmosphere
• Displays professionalism and represents organization in a professional manner
• Strong knowledge of HIPPA privacy and security rules and regulations