Multi-State Insurance Credentialing Specialist

QUALITY MEDICAL IMAGING OF NEVADA; Las Vegas (NV); On-site; USD 45,000 - 65,000; Full time

Job summary

QUALITY MEDICAL IMAGING OF NEVADA is seeking an Insurance Enrollment Specialist to manage enrollments for Medicare, Medicaid, commercial plans, and related credentialing. You will handle payer participation, electronic enrollments, and portal access across several states, coordinating with Billing and management.

The role requires attention to detail, strong organization, and communication skills to track approvals, renewals, and eligibility while supporting verification and authorization for

Qualifications

• Experience with insurance payer enrollment for a healthcare organization, including Medicare, Medicaid, and commercial plans.
• Knowledge of billing NPIs, taxonomy, payer participation, PECOS, and Medicaid enrollment portals.
• Experience with EDI, ERA, EFT, and payer portals preferred.
• Strong organization, follow-up, problem-solving, and communication skills.
• Multi-state enrollment or mobile imaging experience is a plus.

Responsibilities

• Handle enrollment and renewals with Medicare, Medicaid, commercial insurance plans, Medicare Advantage, and Medicaid managed care plans.
• Confirm which plans QMI participates with, which applications are pending, and when coverage takes effect.
• Check that payers have the correct QMI business name, tax ID.
• Responsible to complete all credentialing forms based on individual carriers.
• Responsible for contacting new insurance networks and continue to follow up regarding participation.
• Responsible for communicating credentialing and participation information to QMI employees.
• Set up and track electronic claim, remittance, and payment enrollments (EDI, ERA, and EFT).
• Work with Billing and clearinghouse support to confirm payer IDs, connections, and enrollment approvals.
• Keep Billing informed when a payer connection is ready to use.
• Manage or coordinate administrator access for insurance portals, including Availity, Optum, and state Medicaid systems.
• Add or remove approved staff access and help resolve login or permission issues.
• Keep an up-to-date list of portals, administrators, users, and support contacts.
• Keep one clear tracker showing each payer, plan, state, QMI entity/NPI, enrollment status, effective date, and next step.
• Save applications, approvals, payer emails, contracts, and other enrollment records where management can find them.
• Report pending applications, upcoming renewals, and unresolved problems to management.
• Works as a liaison between facilities and radiology companies for credentialing purposes.
• Research problems Billing identifies that are caused by enrollment, network status, incorrect payer records, or electronic enrollment setup.
• Work with the payer to correct the problem and tell Billing when the issue is resolved and whether affected claims can be resubmitted.
• Routine claim denials, EOB review, aging, payment posting, and collections remain with Billing.
• Maintain contacts with payer enrollment and provider relations departments.
• Follow up on contracting and participation requests. Management handles contract negotiations and final approvals.
• Find out what each payer requires for QMI as a mobile imaging supplier.
• Track Medicare and Medicaid revalidations, payer renewals, and other organizational enrollment deadlines.
• Coordinate site surveys and related paperwork with management.
• Maintain organizational licenses or certifications needed for payer enrollment.
• Assists Intake and Billing with insurance verification issues related to payer enrollment, participation status, and coverage discrepancies as needed.
• Obtain and follow up on prior authorizations for diagnostic imaging services.
• Verify payer-specific authorization requirements and submit necessary clinical documentation.
• Track pending authorizations, approvals, denials, and expiration dates.
• Responsible for updating each account verified to indicate that verification has been complete.
• Communicate authorization status and outstanding requirements to Intake and Billing.
• Verify licensing of modality by state for Physicians who read for contracted providers.
• Work with intake to ensure they consistently have the most up to date reading doctor information.

Skills

Multistate enrollment

Payer portal management

EDI/ERA/EFT setup

Communication skills

Attention to detail

Education

High school diploma or equivalent

Tools

Availity

Optum

Job description

QUALITY MEDICAL IMAGING OF NEVADA is seeking an Insurance Enrollment Specialist to manage enrollments for Medicare, Medicaid, commercial plans, and related credentialing. You will handle payer participation, electronic enrollments, and portal access across several states, coordinating with Billing and management.

The role requires attention to detail, strong organization, and communication skills to track approvals, renewals, and eligibility while supporting verification and authorization for