Green Bay - 4026 - Credentialing Specialist

Caravel Autism Health, LLC; Green Bay (WI); Remote; USD 25,000 - 28,000; Full time

Job summary

Caravel Autism Health, LLC is seeking a Credentialing Specialist in Green Bay, WI (remote). The role oversees all credentialing activities, handles applications, and follows up with providers and payors on incomplete items to keep contracts current.

You will review new payor contracts, coordinate with departments, and support process improvements while ensuring accuracy and timeliness. A Bachelor's degree in healthcare or business and 3+ years of medical insurance experience are required.

Qualifications

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

Responsibilities

• Oversee credentialing activities and submission of applications.
• Follow up with providers and payors on incomplete items to ensure timely processing.
• Work with payors to add new locations to existing contracts and maintain relationships.

Skills

Medical billing

ICD-10/CPT coding

HIPAA knowledge

Leadership

Interpersonal skills

Communication

Independent & team

Education

Bachelor's degree

Certification preferred

Job description

Green Bay - 4026 - Credentialing Specialist Caravel Autism Health

Compensation $18.00 - $20.00/hour

Description

Credentialing Specialist (Remote in Green Bay, WI)

Job Description

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

Essential Functions

Responsible for the oversight of all credentialing activities. This includes completion and submission of applications and following up with providers and payors on incomplete items.

• 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

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